F-18-FDG-PET Confined Radiotherapy of Locally Advanced NSCLC With Concomitant Chemotherapy: Results of the PET-PLAN Pilot Trial

Journal Article · Tue Nov 15 04:00:00 EST 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2011.01.020· OSTI ID:22054378

Fleckenstein, Jochen ^[1]; Hellwig, Dirk ^[2]; Kremp, Stephanie ^[1]; Grgic, Aleksandar ^[2]; Groeschel, Andreas ^[3]; Kirsch, Carl-Martin ^[2]; Nestle, Ursula ^[2]; Ruebe, Christian ^[1]

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1. Department of Radiotherapy and Radiation Oncology, Saarland University Medical School, Homburg (Germany)
2. Department of Nuclear Medicine, Saarland University Medical School, Homburg (Germany)
3. Department of Internal Medicine V, Saarland University Medical School, Homburg (Germany)

Purpose: The integration of fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) in the process of radiotherapy (RT) planning of locally advanced non-small-cell lung cancer (NSCLC) may improve diagnostic accuracy and minimize interobserver variability compared with target volume definition solely based on computed tomography. Furthermore, irradiating only FDG-PET-positive findings and omitting elective nodal regions may allow dose escalation by treating smaller volumes. The aim of this prospective pilot trial was to evaluate the therapeutic safety of FDG-PET-based RT treatment planning with an autocontour-derived delineation of the primary tumor. Methods and Materials: Eligible patients had Stages II-III inoperable NSCLC, and simultaneous, platinum-based radiochemotherapy was indicated. FDG-PET and computed tomography acquisitions in RT treatment planning position were coregistered. The clinical target volume (CTV) included the FDG-PET-defined primary tumor, which was autodelineated with a source-to-background algorithm, plus FDG-PET-positive lymph node stations. Limited by dose restrictions for normal tissues, prescribed total doses were in the range of 66.6 to 73.8 Gy. The primary endpoint was the rate of out-of-field isolated nodal recurrences (INR). Results: As per intent to treat, 32 patients received radiochemotherapy. In 15 of these patients, dose escalation above 66.6 Gy was achieved. No Grade 4 toxicities occurred. After a median follow-up time of 27.2 months, the estimated median survival time was 19.3 months. During the observation period, one INR was observed in 23 evaluable patients. Conclusions: FDG-PET-confined target volume definition in radiochemotherapy of NSCLC, based on a contrast-oriented source-to-background algorithm, was associated with a low risk of INR. It might provide improved tumor control because of dose escalation.

• OSTI ID: 22054378
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 81; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ACCURACY
ALGORITHMS
CHEMOTHERAPY
FLUORINE 18
FLUORODEOXYGLUCOSE
HAZARDS
LUNGS
LYMPH NODES
NEOPLASMS
PATIENTS
PLANNING
PLATINUM
POSITRON COMPUTED TOMOGRAPHY
RADIATION DOSES
RADIOTHERAPY
SURVIVAL TIME
TOXICITY