Target volume definition for 18F-FDG PET-positive lymph nodes in radiotherapy of patients with non-small cell lung cancer

  • Ursula NestleEmail author
  • Andrea Schaefer-Schuler
  • Stephanie Kremp
  • Andreas Groeschel
  • Dirk Hellwig
  • Christian Rübe
  • Carl-Martin Kirsch
Original article



FDG PET is increasingly used in radiotherapy planning. Recently, we demonstrated substantial differences in target volumes when applying different methods of FDG-based contouring in primary lung tumours (Nestle et al., J Nucl Med 2005;46:1342–8). This paper focusses on FDG-positive mediastinal lymph nodes (LNPET).


In our institution, 51 NSCLC patients who were candidates for radiotherapy prospectively underwent staging FDG PET followed by a thoracic PET scan in the treatment position and a planning CT. Eleven of them had 32 distinguishable non-confluent mediastinal or hilar nodal FDG accumulations (LNPET). For these, sets of gross tumour volumes (GTVs) were generated at both acquisition times by four different PET-based contouring methods (visual: GTVvis; 40% SUVmax: GTV40; SUV=2.5: GTV2.5; target/background (T/B) algorithm: GTVbg).


All differences concerning GTV sizes were within the range of the resolution of the PET system. The detectability and technical delineability of the GTVs were significantly better in the late scans (e.g. p = 0.02 for diagnostic application of SUVmax = 2.5; p = 0.0001 for technical delineability by GTV2.5; p = 0.003 by GTV40), favouring the GTVbg method owing to satisfactory overall applicability and independence of GTVs from acquisition time. Compared with CT, the majority of PET-based GTVs were larger, probably owing to resolution effects, with a possible influence of lesion movements.


For nodal GTVs, different methods of contouring did not lead to clinically relevant differences in volumes. However, there were significant differences in technical delineability, especially after early acquisition. Overall, our data favour a late acquisition of FDG PET scans for radiotherapy planning, and the use of a T/B algorithm for GTV contouring.


FDG PET Radiotherapy planning Lymph nodes Contouring 



The authors wish to thank the staff of the two departments, and especially Ms. Susanne Bock, for their help in data acquisition. Furthermore, we thank Dr. Aleks Grgic for his assistance in radiodiagnostic questions, and Mr. Andrew Page for his help in the wording of the manuscript.


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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Ursula Nestle
    • 1
    Email author
  • Andrea Schaefer-Schuler
    • 1
  • Stephanie Kremp
    • 2
  • Andreas Groeschel
    • 3
  • Dirk Hellwig
    • 1
  • Christian Rübe
    • 2
  • Carl-Martin Kirsch
    • 1
  1. 1.Department of Nuclear MedicineSaarland University Medical CentreHomburg/SaarGermany
  2. 2.Department of Radio-oncologySaarland University Medical CentreHomburg/SaarGermany
  3. 3.Department of PneumologySaarland University Medical CentreHomburg/SaarGermany

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