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Role of PET/CT in Radiotherapy Treatment Planning

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Basic Science of PET Imaging

Abstract

This chapter focuses on the rationale, target validation, dose prescription verification and evaluation, and recent clinical achievements in the field of integrating positron emission tomography imaging into radiotherapy treatment planning. Application of functional imaging to radiotherapy is a rapidly expanding field with the development of new modalities and techniques. Functional imaging of positron emission tomography in conjunction with radiotherapy provides new avenues toward the clinical application of dose painting as a new radiotherapy strategy delivering optimized dose redistribution according to the functional imaging information to further improve tumor control.

New biological imaging methodologies mainly based on positron emission tomography/computed tomography, magnetic resonance imaging, and magnetic resonance spectroscopy imaging, in conjunction with radiotherapy, make dose painting possible. It can be used to draw a three-dimensional map of radiobiological relevant parameters as its inherent potential to trace the real target volume, consisting of tumor cells that require a therapeutic dose to control the disease. Positron emission tomography/computed tomography is outstanding and widely used in daily clinical practice. It offers molecular biological information on the tumor microenvironment in addition to anatomical imaging and shows significant biological heterogeneity of tumors, such as metabolism, proliferation, hypoxia, radioresistance cell density, and perfusion.

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Abbreviations

3D:

Three dimensional

AC:

Attenuation correction

ACE:

11C-acetate

AMT:

Alpha-[11C]methyl-L-tryptophan

ART:

Adaptive radiotherapy

ATSM:

Copper-64 diacetyl-bis (N4-methy-lthiosemicarbazone)

BTV:

Biological target volume

CECT:

Contrast-enhanced computed tomography

CH:

Chemotherapy

CHO:

11C/18F-choline

CMR:

Complete metabolic response

CRC:

Colorectal carcinoma

CRT:

Chemo radiation therapy

CT:

Computed tomography

CTV:

Clinical target volume

DLBCL:

Diffuse large B-cell lymphoma

DPBC:

Dose painting by contours

DPBN:

Dose painting by numbers

EBRT:

External beam radiation therapy

EORTC:

European Organization for Research and Treatment of Cancer

EP:

Extramedullary plasmacytoma

FAZA:

18F-fluoroazomycinarabinoside

FDA:

Food and Drug Administration

FDG:

18F-fluorodeoxyglucose

FDOPA:

18F-3,4-dihydroxy-6-18F-fluoro-l-phenylalanine

FES:

18F-fluoroestradiol

FET:

18F-fluoro-ethyl-tyrosine

FIGO:

International Federation of Gynecology and Obstetrics

FL:

Follicular lymphoma

FLIPI:

Follicular Lymphoma International Prognostic Index

FLT:

18F-fluorothymidine

FMISO:

18F-fluoromisonidazole

GTV:

Gross tumor volume

HL:

Hodgkin’s lymphoma

HNC:

Head and neck cancers

IMAT:

Intensity-modulated arc therapy

IMRT:

Intensity-modulated radiation therapy

INRT:

Involved node radiation therapy

ISRT:

Involved site radiation therapy

LARC:

Locally advanced rectal cancer

LC:

Lung cancer

LN:

Lymph node

LRC:

Locoregional control

MET:

11C-methionine

MM:

Multiple myeloma

MRI:

Magnetic resonance imaging

NHL:

Non-Hodgkin’s lymphoma

NPV:

Negative predictive value

NSCLC:

Non-small-cell lung cancer

OAR:

Organ at risk

OS:

Overall survival

PCa:

Prostate cancer

pCR:

Pathological complete response

PET:

Positron emission tomography

PMR:

Partial metabolic response

PP:

Paraprotein

pPR:

Pathological partial response

PPV:

Positive predictive value

PTV:

Planning target volume

RC:

Renal cancer

RECIST:

Response criteria in solid tumor

RIWGRC:

Revised IWG response criteria

ROI:

Region of interest

RT:

Radiation therapy

SBP:

Solitary bone plasmacytoma

SBRT:

Stereotactic body radiation therapy

SIB:

Simultaneous integrated boost

SMD:

Stable metabolic disease

SP:

Solitary plasmacytoma

SUV:

Standardized uptake values

T1-gad:

Gadolinium-enhanced T1 weighted

TCP:

Tumor control probability

TVD:

Target volume delineation

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Picchio, M., Incerti, E., Di Muzio, N. (2017). Role of PET/CT in Radiotherapy Treatment Planning. In: Khalil, M. (eds) Basic Science of PET Imaging. Springer, Cham. https://doi.org/10.1007/978-3-319-40070-9_22

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