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18F-FDG PET Definition of Gross Tumor Volume for Radiotherapy of Non–Small Cell Lung Cancer: Is a Single Standardized Uptake Value Threshold Approach Appropriate?

Kenneth J. Biehl1, Feng-Ming Kong2, Farrokh Dehdashti3,4, Jian-Yue Jin5, Sasa Mutic1, Issam El Naqa1,4, Barry A. Siegel3,4 and Jeffrey D. Bradley1,4

1 Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri; 2 Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; 3 Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; 4 Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri; and 5 Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan


Figure 1
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  		FIGURE 1.  (A) CTGTV vs. PETGTV-CTGTV at threshold of 20%. (B) CTGTV vs. optimal threshold with best-fit logarithmic regression curve.

 

Figure 2
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  		FIGURE 2.  Fused PET and CT coronal images of patient with stage I NSCLC. CT image of tumor (white) can be seen within larger PET image of tumor. Contours represent gross tumor volume (inner contour), clinical target volume (middle contour), and planning target volume (outer contour).

 




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