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A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the and to the International Research Group of Immunoscintigraphy
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index (SciSearch), Scopus
Impact Factor 2,413
Online ISSN 1827-1936
Messa C. 1,2,3, Ceresoli G. L. 4, Rizzo G. 2,3, Artioli D. 1, Cattaneo M. 5, Castellone P. 5, Gregorc V. 4, Picchio M. 3, Landoni C. 1,3, Fazio F. 1,2,3,4
1 DNTB, School of Medicine University of Milano-Bicocca, Milan, Italy
2 IBFM-CNR, Institute for Molecular Bioimaging and Physiology, Milan, Italy
3 Department of Nuclear Medicine, Scientific Institute H. S. Raffaele, Milan, Italy
4 Department of Radiation Oncology and Clinical Oncology,Scientific Institute H. S. Raffaele, Milan, Italy
5 Department of Radiation Physics Scientific Institute H. S. Raffaele, Milan, Italy
Aim. To prospectively evaluate the impact of coregistered positron emission tomography (PET) and computed tomography (CT) in 3D conformal radiotherapy (3D-CRT) planning in patients with non-small lung cancer (NSCLC).
Methods. Twenty-one patients (median age: 57 years; range: 42-80 years) referred to 3D-CRT for NSCLC were recruited. Positron emission tomography with 18F-fluorodeoxyglucose ([18F]FDG-PET) and conventional CT images were coregistered (PET/CT images) using a commercial software package based on surface matching technique. Neoplastic areas were contoured on [18F]FDG-PET images with the aid of the correspondent CT image by a nuclear medicine physician. CT images and their relative PET contours were then transferred to treatment planning system. A radiation oncologist firstly contoured clinical target volumes (CTV) on CT scan alone (CTV-CT), and then on coregistered PET/CT images (CTV-PET/CT). CTV-CT and CTV-PET/CT were compared for each patient; a difference higher than 25% was considered of clinical relevance.
Results. Three patients were shifted to palliative radiotherapy for metastatic disease or very large tumor size, showed by [18F]FDG-PET. Of the remaining 18 patients a CTV change, after inclusion of PET/CT data, was observed in 10/18 cases (55%): larger in 7/18 (range 33-279%) and smaller in 3/18 patients (range 26-34%), mainly due to inclusion or exclusion of lymph-nodal disease and to better definition of tumor extent. CTV changes smaller than 25% occurred in the remaining 8/18 patients.
Conclusion. [18F]FDG-PET and CT images co-registration in radiotherapy treatment planning led to a change in CTV definition in the majority of our patients, which may significantly modify management and radiation treatment modality in these patients.