[18F]FDG-positron emission tomography coregistration with computed tomography scans for radiation treatment planning of lymphoma and hematologic malignancies

Stephanie A Terezakis, Margie A. Hunt, Alexander Kowalski, Patrick McCann, C. Ross Schmidtlein, Anne Reiner, Mithat Gönen, Assen S. Kirov, Anne Marie Gonzales, Heiko Schöder, Joachim Yahalom

Research output: Contribution to journalArticle

Abstract

Purpose: Positron emission-tomography (PET) using 2-[18F]fluoro- 2-deoxyglucose (FDG-PET) increases sensitivity and specificity of disease detection in lymphoma and thus is standard in lymphoma management. This study examines the effects of coregistering FDG-PET and computed tomography (CT) (PET/CT) scans on treatment planning for lymphoma patients. Methods and Materials: Twenty-nine patients (30 positive PET scans) underwent PET/CT treatment planning from July 2004 to February 2007 and were retrospectively studied. For each patient, gross tumor volume was blindly contoured on the CT-only and PET/CT studies by a radiation oncologist. Treatment plans were generated for both the CT-only and PET/CT planning target volumes (PTVs) for all patients. Normal tissue doses and PTV coverage were evaluated using dose - volume histograms for all sites. Results: Thirty-two treatment sites were evaluated. Twenty-one patients had non-Hodgkin lymphoma, 5 patients had Hodgkin lymphoma, and 3 patients had plasma cell neoplasms. Previously undetected FDG-avid sites were identified in 3 patients during PET/CT simulation, resulting in one additional treatment field. Due to unexpected PET/CT simulation findings, 2 patients did not proceed with radiation treatment. The addition of PET changed the volume of 23 sites (72%). The PTV was increased in 15 sites (47%) by a median of 11% (range, 6-40%) and reduced in 8 sites (25%) by a median of 20% (range, 6%-75%). In six (19%) replanned sites, the CT-based treatment plan would not have adequately covered the PTV defined by PET/CT. Conclusions: Incorporation of FDG-PET into CT-based treatment planning for lymphoma patients resulted in considerable changes in management, volume definition, and normal tissue dosimetry for a significant number of patients.

Original languageEnglish (US)
Pages (from-to)615-622
Number of pages8
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume81
Issue number3
DOIs
StatePublished - Nov 1 2011
Externally publishedYes

Fingerprint

Fluorodeoxyglucose F18
Hematologic Neoplasms
Positron-Emission Tomography
planning
positrons
Lymphoma
tomography
Tomography
Radiation
radiation
Therapeutics
Plasma Cell Neoplasms
Positron Emission Tomography Computed Tomography
Tumor Burden
Hodgkin Disease
Non-Hodgkin's Lymphoma
Sensitivity and Specificity

Keywords

  • [F]FDG-PET
  • Involved field radiation
  • Lymphoma
  • PET/CT radiation planning
  • Target volume definition

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

[18F]FDG-positron emission tomography coregistration with computed tomography scans for radiation treatment planning of lymphoma and hematologic malignancies. / Terezakis, Stephanie A; Hunt, Margie A.; Kowalski, Alexander; McCann, Patrick; Schmidtlein, C. Ross; Reiner, Anne; Gönen, Mithat; Kirov, Assen S.; Gonzales, Anne Marie; Schöder, Heiko; Yahalom, Joachim.

In: International Journal of Radiation Oncology, Biology, Physics, Vol. 81, No. 3, 01.11.2011, p. 615-622.

Research output: Contribution to journalArticle

Terezakis, SA, Hunt, MA, Kowalski, A, McCann, P, Schmidtlein, CR, Reiner, A, Gönen, M, Kirov, AS, Gonzales, AM, Schöder, H & Yahalom, J 2011, '[18F]FDG-positron emission tomography coregistration with computed tomography scans for radiation treatment planning of lymphoma and hematologic malignancies', International Journal of Radiation Oncology, Biology, Physics, vol. 81, no. 3, pp. 615-622. https://doi.org/10.1016/j.ijrobp.2010.06.044
Terezakis, Stephanie A ; Hunt, Margie A. ; Kowalski, Alexander ; McCann, Patrick ; Schmidtlein, C. Ross ; Reiner, Anne ; Gönen, Mithat ; Kirov, Assen S. ; Gonzales, Anne Marie ; Schöder, Heiko ; Yahalom, Joachim. / [18F]FDG-positron emission tomography coregistration with computed tomography scans for radiation treatment planning of lymphoma and hematologic malignancies. In: International Journal of Radiation Oncology, Biology, Physics. 2011 ; Vol. 81, No. 3. pp. 615-622.
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abstract = "Purpose: Positron emission-tomography (PET) using 2-[18F]fluoro- 2-deoxyglucose (FDG-PET) increases sensitivity and specificity of disease detection in lymphoma and thus is standard in lymphoma management. This study examines the effects of coregistering FDG-PET and computed tomography (CT) (PET/CT) scans on treatment planning for lymphoma patients. Methods and Materials: Twenty-nine patients (30 positive PET scans) underwent PET/CT treatment planning from July 2004 to February 2007 and were retrospectively studied. For each patient, gross tumor volume was blindly contoured on the CT-only and PET/CT studies by a radiation oncologist. Treatment plans were generated for both the CT-only and PET/CT planning target volumes (PTVs) for all patients. Normal tissue doses and PTV coverage were evaluated using dose - volume histograms for all sites. Results: Thirty-two treatment sites were evaluated. Twenty-one patients had non-Hodgkin lymphoma, 5 patients had Hodgkin lymphoma, and 3 patients had plasma cell neoplasms. Previously undetected FDG-avid sites were identified in 3 patients during PET/CT simulation, resulting in one additional treatment field. Due to unexpected PET/CT simulation findings, 2 patients did not proceed with radiation treatment. The addition of PET changed the volume of 23 sites (72{\%}). The PTV was increased in 15 sites (47{\%}) by a median of 11{\%} (range, 6-40{\%}) and reduced in 8 sites (25{\%}) by a median of 20{\%} (range, 6{\%}-75{\%}). In six (19{\%}) replanned sites, the CT-based treatment plan would not have adequately covered the PTV defined by PET/CT. Conclusions: Incorporation of FDG-PET into CT-based treatment planning for lymphoma patients resulted in considerable changes in management, volume definition, and normal tissue dosimetry for a significant number of patients.",
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AU - Kowalski, Alexander

AU - McCann, Patrick

AU - Schmidtlein, C. Ross

AU - Reiner, Anne

AU - Gönen, Mithat

AU - Kirov, Assen S.

AU - Gonzales, Anne Marie

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