Clinical validation of FDG-PET/CT in the radiation treatment planning for patients with oesophageal cancer

Christina T Muijs; Jannet C Beukema; Dankert Woutersen; Veronique E Mul; Maaike J Berveling; Jan Pruim; Eric J van der Jagt; Geke A P Hospers; Henk Groen; John Th Plukker; Johannes A Langendijk

doi:10.1016/j.radonc.2014.10.016

Clinical validation of FDG-PET/CT in the radiation treatment planning for patients with oesophageal cancer

Radiother Oncol. 2014 Nov;113(2):188-92. doi: 10.1016/j.radonc.2014.10.016. Epub 2014 Nov 29.

Affiliations

¹ Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: [email protected].
² Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³ Department of Radiation Oncology, Medical Spectrum Twente, Enschede, The Netherlands.
⁴ Department of Molecular Imaging and Nuclear Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Nuclear Medicine, Stellenbosch University, South Africa.
⁵ Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁶ Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁷ Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁸ Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

PMID: 25467002
DOI: 10.1016/j.radonc.2014.10.016

Abstract

Background: The aim of this prospective study was to determine the proportion of locoregional recurrences (LRRs) that could have been prevented if radiotherapy treatment planning for oesophageal cancer was based on PET/CT instead of CT.

Materials and methods: Ninety oesophageal cancer patients, eligible for high dose (neo-adjuvant) (chemo)radiotherapy, were included. All patients underwent a planning FDG-PET/CT-scan. Radiotherapy target volumes (TVs) were delineated on CT and patients were treated according to the CT-based treatment plans. The PET images remained blinded. After treatment, TVs were adjusted based on PET/CT, when appropriate. Follow up included CT-thorax/abdomen every 6months. If LRR was suspected, a PET/CT was conducted and the site of recurrence was compared to the original TVs. If the LRR was located outside the CT-based clinical TV (CTV) and inside the PET/CT-based CTV, we considered this LRR possibly preventable.

Results: Based on PET/CT, the gross tumour volume (GTV) was larger in 23% and smaller in 27% of the cases. In 32 patients (36%), >5% of the PET/CT-based GTV would be missed if the treatment planning was based on CT. The median follow up was 29months. LRRs were seen in 10 patients (11%). There were 3 in-field recurrences, 4 regional recurrences outside both CT-based and PET/CT-based CTV and 3 recurrences at the anastomosis without changes in TV by PET/CT; none of these recurrences were considered preventable by PET/CT.

Conclusion: No LRR was found after CT-based radiotherapy that could have been prevented by PET/CT. The value of PET/CT for radiotherapy seems limited.

Keywords: FDG-PET/CT; Oesophageal cancer; Radiotherapy planning.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Esophageal Neoplasms / diagnostic imaging*
Esophageal Neoplasms / radiotherapy*
Female
Fluorodeoxyglucose F18*
Humans
Male
Middle Aged
Multimodal Imaging / methods
Neoplasm Recurrence, Local / diagnosis
Neoplasm Recurrence, Local / prevention & control*
Positron-Emission Tomography / methods
Prospective Studies
Radiopharmaceuticals*
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted / methods*
Radiotherapy, Conformal / methods
Tomography, X-Ray Computed / methods

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18