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PET-Based Treatment Planning in Radiotherapy: A New Standard?

¹ Radiation Oncology Department, Université Catholique de Louvain, St. Luc University Hospital, Brussels, Belgium; ² Center for Molecular Imaging and Experimental Radiotherapy, Université Catholique de Louvain, St. Luc University Hospital, Brussels, Belgium; ³ Radiation Oncology Department, Katholiek Universiteit Leuven, Gasthuisberg University Hospital, Leuven, Belgium; and ⁴ Nuclear Medicine Department, Université Catholique de Louvain, St. Luc University Hospital, Brussels, Belgium

View larger version (67K): [in this window] [in a new window]   FIGURE 1.  Role of 18F-FDG PET in delineating volume of lung cancer. (A) Axial, coronal, and sagittal CT slices from patient with lung cancer located in left hilar region, associated with retroobstructive atelectasis of entire left lung, and associated with major pleural effusion. (B) Metabolic information provided by 18F-FDG PET shows that tumor tissue is confined to hilum. Delineation of tumor margin is easier and more accurate with help of 18F-FDG PET, allowing for significant modification of target volume.

View larger version (38K): [in this window] [in a new window]   FIGURE 2.  PET/CT with 18F-FDG shows paratracheal adenopathy proven to be malignant by fine-needle aspiration cytology for patient with esophageal cancer.

View larger version (61K): [in this window] [in a new window]   FIGURE 3.  Imaging studies performed before and during course of treatment for patient with rectal cancer. (Upper row) Images from CT performed in prone position before chemoradiotherapy (RT), during chemoradiotherapy, and at time of surgery. (Middle row) Images from MRI performed in supine position before chemoradiotherapy, during chemoradiotherapy, and at time of surgery. (Lower row) Images from 18F-FDG PET performed before chemoradiotherapy, during chemoradiotherapy, and at time of surgery. Tumor (red arrows) shows high level of uptake of 18F-FDG before start of treatment; 18F-FDG signal decreases during treatment and is lowest at time of surgery. 18F-FDG PET can help in delineating GTV before treatment and in replanning radiation treatment during course of treatment. White arrows indicate urinary bladder.

View larger version (57K): [in this window] [in a new window]   FIGURE 4.  Correlation of resection specimen with different imaging modalities for patient with rectal cancer. (Column 1) Macroscopic section through rectal cancer resection specimen from top to bottom. (Columns 2–4) Correlating imaging studies: MRI, CT, and 18F-FDG PET, respectively (all performed in prone position). This figure illustrates how molecular imaging modalities can be validated by correlation with pathologic specimen.

View larger version (29K): [in this window] [in a new window]   FIGURE 5.  Patient with T4 N3 M0 squamous cell carcinoma of right piriform sinus. CT, MRI (T2-weighted fat suppression), and 18F-FDG PET were performed before treatment (PRE-R) and during wk 3 (26 Gy) and wk 5 (46 Gy) of treatment with chemoradiotherapy. Three sets of images were coregistered by use of semiautomatic tool based on isocontouring. Substantial reduction in tumor volume and metabolic activity can be observed throughout treatment.