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

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

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).

Methods

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).

Results

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.

Conclusion

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.

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Acknowledgements

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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Authors and Affiliations

  1. Department of Nuclear Medicine, Saarland University Medical Centre, 66421, Homburg/Saar, Germany

    Ursula Nestle, Andrea Schaefer-Schuler, Dirk Hellwig & Carl-Martin Kirsch

  2. Department of Radio-oncology, Saarland University Medical Centre, Homburg/Saar, Germany

    Stephanie Kremp & Christian Rübe

  3. Department of Pneumology, Saarland University Medical Centre, Homburg/Saar, Germany

    Andreas Groeschel

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  1. Ursula Nestle
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  2. Andrea Schaefer-Schuler
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  3. Stephanie Kremp
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  4. Andreas Groeschel
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  5. Dirk Hellwig
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  7. Carl-Martin Kirsch
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Correspondence to Ursula Nestle.

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Nestle, U., Schaefer-Schuler, A., Kremp, S. et al. Target volume definition for 18F-FDG PET-positive lymph nodes in radiotherapy of patients with non-small cell lung cancer. Eur J Nucl Med Mol Imaging 34, 453–462 (2007). https://doi.org/10.1007/s00259-006-0252-x

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  • DOI: https://doi.org/10.1007/s00259-006-0252-x

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