Prospective feasibility trial of radiotherapy target definition for head and neck cancer using 3-dimensional PET and CT imaging.

  • Scarfone C
  • Lavely W
  • Cmelak A
 et al. 
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UNLABELLED: The aim of this investigation was to evaluate the influence and accuracy of (18)F-FDG PET in target volume definition as a complementary modality to CT for patients with head and neck cancer (HNC) using dedicated PET and CT scanners. METHODS: Six HNC patients were custom fitted with head and neck and upper body immobilization devices, and conventional radiotherapy CT simulation was performed together with (18)F-FDG PET imaging. Gross target volume (GTV) and pathologic nodal volumes were first defined in the conventional manner based on CT. A segmentation and surface-rendering registration technique was then used to coregister the (18)F-FDG PET and CT planning image datasets. (18)F-FDG PET GTVs were determined and displayed simultaneously with the CT contours. CT GTVs were then modified based on the PET data to form final PET/CT treatment volumes. Five-field intensity-modulated radiation therapy (IMRT) was then used to demonstrate dose targeting to the CT GTV or the PET/CT GTV. RESULTS: One patient was PET-negative after induction chemotherapy. The CT GTV was modified in all remaining patients based on (18)F-FDG PET data. The resulting PET/CT GTV was larger than the original CT volume by an average of 15%. In 5 cases, (18)F-FDG PET identified active lymph nodes that corresponded to lymph nodes contoured on CT. The pathologically enlarged CT lymph nodes were modified to create final lymph node volumes in 3 of 5 cases. In 1 of 6 patients, (18)F-FDG-avid lymph nodes were not identified as pathologic on CT. In 2 of 6 patients, registration of the independently acquired PET and CT data using segmentation and surface rendering resulted in a suboptimal alignment and, therefore, had to be repeated. Radiotherapy planning using IMRT demonstrated the capability of this technique to target anatomic or anatomic/physiologic target volumes. In this manner, metabolically active sites can be intensified to greater daily doses. CONCLUSION: Inclusion of (18)F-FDG PET data resulted in modified target volumes in radiotherapy planning for HNC. PET and CT data acquired on separate, dedicated scanners may be coregistered for therapy planning; however, dual-acquisition PET/CT systems may be considered to reduce the need for reregistrations. It is possible to use IMRT to target dose to metabolically active sites based on coregistered PET/CT data.

Author-supplied keywords

  • 80 and over
  • Adult
  • Aged
  • Computer-Assisted
  • Computer-Assisted: methods
  • Conformal
  • Conformal: methods
  • Emission-Computed
  • Emission-Computed: methods
  • Feasibility Studies
  • Female
  • Fluorodeoxyglucose F18
  • Fluorodeoxyglucose F18: diagnostic use
  • Head and Neck Neoplasms
  • Head and Neck Neoplasms: diagnosis
  • Head and Neck Neoplasms: radiography
  • Head and Neck Neoplasms: radionuclide imaging
  • Head and Neck Neoplasms: radiotherapy
  • Humans
  • Image Interpretation
  • Imaging
  • Male
  • Prospective Studies
  • Radiopharmaceuticals
  • Radiopharmaceuticals: diagnostic use
  • Radiotherapy
  • Radiotherapy Dosage
  • Radiotherapy Planning
  • Sensitivity and Specificity
  • Subtraction Technique
  • Three-Dimensional
  • Three-Dimensional: methods
  • Tomography
  • X-Ray Computed
  • X-Ray Computed: methods

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  • Christopher Scarfone

  • William C Lavely

  • Anthony J Cmelak

  • Dominique Delbeke

  • William H Martin

  • Dean Billheimer

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