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Comparison of positron emission tomography (PET) and computed tomography (CT) for better target volume definition in radiation therapy planning

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Abstract

Background

In cancer patients, positron emission tomography/computed tomography (PET/CT) fused images present less variability in target contouring, respect to use only CT images, respectively. However, the gold standard has not yet been clearly established between radiation oncologists with regard to PET images and the methodology of contouring targets with confidence using PET/CT fused images. The aim of this study was to determine whether integrated PET/CT fused images provide advantages in virtual simulation compared with morphological contouring only with CT.

Material and methods

Thirty cancer patients were evaluated in an adapted PET/CT hybrid in radiotherapy (RT) setup position, with 20 of them being suitable for RT: 17 were suitable for curative intent, which was the group of interest in this study. All image series were sent to the RT work station (WS) where CT and PET series were automatically fused by Digital Imaging and Communications in Medicine (DICOM) in each case. PET series were threshold and were subjected to source-to-background contrast algorithms to finally redefine the original tumour description. Three different radiotherapy plans (RTP) for each patient were compared after targets were contoured: [1] planning over metabolic (PET) contoured targets, [2] planning over only morphologic (CT) targets, and [3] planning over targets obtained for treatment based on fused PET/CT images.

Results

PET/CT findings altered initial-stage planning in four patients (23.5%) because they had been undergoing chemotherapy. Gross target volume (GTV) and planning target volume (PTV) based only on PET showed more homogeneity to obtain mean doses (p = 0.025) with respect to those based on PET/CT, respectively. However, no percentage differences were observed in median PTV doses between the planning methods, although there was higher variability in PET/CT planning. Morphological (CT) and PET/ CT target volumes were more voluminous than metabolic (PET) volumes. On the other hand, 20% of metabolic (PET) PTV were out of those defined by PET/CT. Thoracic RT plans based on PET preserved better bilateral lung [percentage volume of lung irradiated with a dose of 20 Gy (V20); significance, R2 = 0.559, p = 0.006].

Conclusions

For our physicians, PET/CT fused images allowed better contouring of primary tumours in 40% of head and neck cancers and 34% of thoracic cancers. PET/CT provides useful information for virtual simulation therapy. Image treatment and planning in an RT workstation is mandatory.

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Authors and Affiliations

  1. Unitat de Radioteràpia i Oncologia, Hospital Plató, C/ Plató, 21, ES-08006, Barcelona, Spain

    Antoni Vila, Alberto Sánchez-Reyes, Carmen Láinez & Agustí Pedro

  2. Servei d’Oncología Radioteràpica Institut de Malalties Hemato-Oncológiques, Hospital Clinic, Barcelona, Spain

    Carles Conill

  3. Unitat PET - CRC Mar, CRC Corporació Sanitària, Barcelona, Spain

    Juan Domingo Gispert

  4. Institut d’Alta Tecnologia - PRBB, CRC Corporació Sanitària, Barcelona, Spain

    Carlos Trampal

  5. Servei d’Oncología Radioteràpica, Institut Català d’Oncología, ICO-Girona, Girona, Spain

    Jordi Vayreda

Authors
  1. Antoni Vila
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  2. Alberto Sánchez-Reyes
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  3. Carles Conill
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  4. Juan Domingo Gispert
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  5. Carlos Trampal
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  6. Carmen Láinez
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  7. Jordi Vayreda
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  8. Agustí Pedro
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Correspondence to Antoni Vila.

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Vila, A., Sánchez-Reyes, A., Conill, C. et al. Comparison of positron emission tomography (PET) and computed tomography (CT) for better target volume definition in radiation therapy planning. Clin Transl Oncol 12, 367–373 (2010). https://doi.org/10.1007/s12094-010-0518-4

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  • DOI: https://doi.org/10.1007/s12094-010-0518-4

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