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

Abstract

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 27.2more » 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.« less

Authors:
 [1];  [2];  [1];  [2];  [3];  [2];  [2];  [4];  [1]
  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)
  4. (Germany)
Publication Date:
OSTI Identifier:
22054378
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 81; Journal Issue: 4; Other Information: Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
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

Citation Formats

Fleckenstein, Jochen, Hellwig, Dirk, Kremp, Stephanie, Grgic, Aleksandar, Groeschel, Andreas, Kirsch, Carl-Martin, Nestle, Ursula, Clinic for Radiotherapy, University Hospital, Freiburg, and Ruebe, Christian, E-mail: christian.ruebe@uks.eu. F-18-FDG-PET Confined Radiotherapy of Locally Advanced NSCLC With Concomitant Chemotherapy: Results of the PET-PLAN Pilot Trial. United States: N. p., 2011. Web. doi:10.1016/J.IJROBP.2011.01.020.
Fleckenstein, Jochen, Hellwig, Dirk, Kremp, Stephanie, Grgic, Aleksandar, Groeschel, Andreas, Kirsch, Carl-Martin, Nestle, Ursula, Clinic for Radiotherapy, University Hospital, Freiburg, & Ruebe, Christian, E-mail: christian.ruebe@uks.eu. F-18-FDG-PET Confined Radiotherapy of Locally Advanced NSCLC With Concomitant Chemotherapy: Results of the PET-PLAN Pilot Trial. United States. doi:10.1016/J.IJROBP.2011.01.020.
Fleckenstein, Jochen, Hellwig, Dirk, Kremp, Stephanie, Grgic, Aleksandar, Groeschel, Andreas, Kirsch, Carl-Martin, Nestle, Ursula, Clinic for Radiotherapy, University Hospital, Freiburg, and Ruebe, Christian, E-mail: christian.ruebe@uks.eu. Tue . "F-18-FDG-PET Confined Radiotherapy of Locally Advanced NSCLC With Concomitant Chemotherapy: Results of the PET-PLAN Pilot Trial". United States. doi:10.1016/J.IJROBP.2011.01.020.
@article{osti_22054378,
title = {F-18-FDG-PET Confined Radiotherapy of Locally Advanced NSCLC With Concomitant Chemotherapy: Results of the PET-PLAN Pilot Trial},
author = {Fleckenstein, Jochen and Hellwig, Dirk and Kremp, Stephanie and Grgic, Aleksandar and Groeschel, Andreas and Kirsch, Carl-Martin and Nestle, Ursula and Clinic for Radiotherapy, University Hospital, Freiburg and Ruebe, Christian, E-mail: christian.ruebe@uks.eu},
abstractNote = {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.},
doi = {10.1016/J.IJROBP.2011.01.020},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 81,
place = {United States},
year = {Tue Nov 15 00:00:00 EST 2011},
month = {Tue Nov 15 00:00:00 EST 2011}
}