Role of FDG-PET in the Implementation of Involved-Node Radiation Therapy for Hodgkin Lymphoma Patients

Journal Article · Fri Aug 01 04:00:00 EDT 2014 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2014.04.026· OSTI ID:22420392

Girinsky, Théodore ^[1]; Aupérin, Anne ^[2]; Ribrag, Vincent ^[3]; Elleuch, Manel ^[4]; Fermé, Christophe ^[3]; Bonniaud, Guillaume ^[5]; Ruelle, Claude ^[6]; Alberini, Jean-Louis ^[7]; Celebic, Aljosa ^[2]; Edeline, Véronique ^[7]

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1. Department of Radiotherapy, Institut Gustave Roussy, Villejuif (France)
2. Department of Biostatistics and Epidemiology, Institut Gustave Roussy, Villejuif (France)
3. Department of Medicine, Institut Gustave Roussy, Villejuif (France)
4. Department of Imaging, Institut Gustave Roussy, Villejuif (France)
5. Department of Medical Physics, Institut Gustave Roussy, Villejuif (France)
6. Department of Information Technology, Institut Gustave Roussy, Villejuif (France)
7. Department of Imaging, Institut Curie R. Huguenin Hospital, Saint-Cloud (France)

Purpose: This study examines the role of {sup 18}F-labeled fluorodeoxyglucose positron emission tomography (FDG-PET) in the implementation of involved-node radiation therapy (INRT) in patients treated for clinical stages (CS) I/II supradiaphragmatic Hodgkin lymphoma (HL). Methods and Material: Patients with untreated CS I/II HL enrolled in the randomized EORTC/LYSA/FIL Intergroup H10 trial and participating in a real-time prospective quality assurance program were prospectively included in this study. Data were electronically obtained from 18 French cancer centers. All patients underwent APET-computed tomography (PET-CT) and a post-chemotherapy planning CT scanning. The pre-chemotherapy gross tumor volume (GTV) and the postchemotherapy clinical target volume (CTV) were first delineated on CT only by the radiation oncologist. The planning PET was then co-registered, and the delineated volumes were jointly analyzed by the radiation oncologist and the nuclear medicine physician. Lymph nodes undetected on CT but FDG-avid were recorded, and the previously determined GTV and CTV were modified according to FDG-PET results. Results: From March 2007 to February 2010, 135 patients were included in the study. PET-CT identified at least 1 additional FDG-avid lymph node in 95 of 135 patients (70.4%; 95% confidence interval [CI]: 61.9%-77.9%) and 1 additional lymph node area in 55 of 135 patients (40.7%; 95% CI: 32.4%-49.5%). The mean increases in the GTV and CTV were 8.8% and 7.1%, respectively. The systematic addition of PET to CT led to a CTV increase in 60% of the patients. Conclusions: Pre-chemotherapy FDG-PET leads to significantly better INRT delineation without necessarily increasing radiation volumes.

• OSTI ID: 22420392
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 89; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CAT SCANNING
CHEMOTHERAPY
FLUORINE 18
FLUORODEOXYGLUCOSE
HODGKINS DISEASE
LYMPH NODES
MEDICAL PERSONNEL
PATIENTS
PLANNING
POSITRON COMPUTED TOMOGRAPHY
QUALITY ASSURANCE
RADIOTHERAPY