Abstract
Positron emission tomography (PET) is a major advance in lung cancer imaging and is having an increasing impact on the management of patients with non-small cell lung cancer who are candidates for potentially-curative treatment with radiotherapy. PET imaging, using 18F-flurodeoxyglucose as the tracer, and more recently in the form of FDG-PET/CT is now the most important single imaging modality for staging, patient selection and radiotherapy planning in NSCLC. If scans are acquired under appropriate conditions and the patient is positioned for radiotherapy, a single scan can be used for all of these purposes. In this chapter the role of PET and PET/CT in staging, patient selection and radiotherapy planning are discussed. Additionally, the use of FDG-PET for response assessment is described and finally the potential value of PET tracers other than FDG is considered.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Ball D, Smith J, Wirth A, Mac Manus M (2002) Failure of T stage to predict survival in patients with non-small-cell lung cancer treated by radiotherapy with or without concomitant chemotherapy. Int J Radiat Oncol Biol Phys 54:1007–1013
Bayne M et al (2010) Reproducibility of “intelligent” contouring of gross tumor volume in non-small-cell lung cancer on PET/CT images using a standardized visual method. Int J Radiat Oncol Biol Phys 77:1151–7
Biehl KJ et al (2006) 18F-FDG PET definition of gross tumor volume for radiotherapy of non-small cell lung cancer: is a single standardized uptake value threshold approach appropriate? J Nucl Med 47:1808–1812
Binns DS et al (2011) Compliance with PET acquisition protocols for therapeutic monitoring of erlotinib therapy in an international trial for patients with non-small cell lung cancer. Eur J Nucl Med Mol Imaging 38:642–650
Blum R et al (2004) Impact of positron emission tomography on the management of patients with small-cell lung cancer: preliminary experience. Am J Clin Oncol 27:164–171
Bowden P et al (2002) Measurement of lung tumor volumes using three-dimensional computer planning software. Int J Radiat Oncol Biol Phys 53:566–573
Bradley JD et al (2004) Positron emission tomography in limited-stage small-cell lung cancer: a prospective study. J Clin Oncol 22:3248–3254
Buck AK et al (2010) Economic evaluation of PET and PET/CT in oncology: evidence and methodologic approaches. J Nucl Med Technol 38:6–17
Caldwell CB et al (2001) Observer variation in contouring gross tumor volume in patients with poorly defined non-small-cell lung tumors on CT: the impact of 18FDG-hybrid PET fusion. Int J Radiat Oncol Biol Phys 51:923–931
Dahele M et al (2008) Developing a methodology for three-dimensional correlation of PET-CT images and whole-mount histopathology in non-small-cell lung cancer. Curr Oncol 15:62–69
Deniaud-Alexandre E et al (2005) Impact of computed tomography and 18F-deoxyglucose coincidence detection emission tomography image fusion for optimization of conformal radiotherapy in non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 63:1432–1441
De Ruysscher D et al (2005) Effects of radiotherapy planning with a dedicated combined PET-CT-simulator of patients with non-small cell lung cancer on dose limiting normal tissues and radiation dose-escalation: a planning study. Radiother Oncol 77:5–10
Dunagan D et al (2001) Staging by positron emission tomography predicts survival in patients with non-small cell lung cancer. Chest 119:333–339
Eschmann SM et al (2007) Impact of staging with 18F-FDG-PET on outcome of patients with stage III non-small cell lung cancer: PET identifies potential survivors. Eur J Nucl Med Mol Imaging 34:54–59
Everitt S et al (2009) Imaging cellular proliferation during chemo-radiotherapy: a pilot study of serial 18F-FLT positron emission tomography/computed tomography imaging for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 75:1098–1104
Everitt S et al (2010) High rates of tumor growth and disease progression detected on serial pretreatment fluorodeoxyglucose-positron emission tomography/computed tomography scans in radical radiotherapy candidates with nonsmall cell lung cancer. Cancer 116:5030–5037
Gould MK et al (2003) Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small-cell lung cancer: a meta-analysis. Ann Intern Med 139:879–892
Gregoire V, Haustermans K, Geets X, Roels S, Lonneux M (2007) PET-based treatment planning in radiotherapy: a new standard? J Nucl Med 48(Suppl 1):68S–77S
Hicks RJ (2009) Role of 18F-FDG PET in assessment of response in non-small cell lung cancer. J Nucl Med 50(Suppl 1):31S–42S
Hicks RJ, Mac Manus MP (2003) 18F-FDG PET in candidates for radiation therapy: is it important and how do we validate its impact? J Nucl Med 44:30–32
Hicks RJ et al (2001) (18)F-FDG PET provides high-impact and powerful prognostic stratification in staging newly diagnosed non-small cell lung cancer. J Nucl Med 42:1596–1604
Higashi K et al (2000) FDG PET measurement of the proliferative potential of non-small cell lung cancer. J Nucl Med 41:85–92
Hong R, Halama J, Bova D, Sethi A, Emami B (2007) Correlation of PET standard uptake value and CT window-level thresholds for target delineation in CT-based radiation treatment planning. Int J Radiat Oncol Biol Phys 67:720–726
Jaffe CC (2006) Measures of response: RECIST, WHO, and new alternatives. J Clin Oncol 24:3245–3251
Koizumi M et al (2011) Uptake decrease of proliferative PET tracer FLT in bone marrow after carbon ion therapy in lung cancer. Mol Imaging Biol 13:577–582
Kolodziejczyk M et al (2011) Impact of [(18)F]Fluorodeoxyglucose PET-CT staging on treatment planning in radiotherapy incorporating elective nodal irradiation for non-small-cell lung cancer: a prospective study. Int J Radiat Oncol Biol Phys 80(4):1008–1114
Lever AM, Henderson D, Ellis DA, Corris PA, Gilmartin JJ (1984) Radiation fibrosis mimicking local recurrence in small cell carcinoma of the bronchus. Br J Radiol 57:178–180
Mac Manus MP et al (2010) Association between pulmonary uptake of fluorodeoxyglucose detected by positron emission tomography scanning after radiation therapy for non-small-cell lung cancer and radiation pneumonitis. Int J Radiat Oncol Biol Phys 80:1365–1371
Mac Manus MP et al (2001) F-18 fluorodeoxyglucose positron emission tomography staging in radical radiotherapy candidates with nonsmall cell lung carcinoma: powerful correlation with survival and high impact on treatment. Cancer 92:886–895
Mac Manus MP et al (2002) Early mortality after radical radiotherapy for non-small-cell lung cancer: comparison of PET-staged and conventionally staged cohorts treated at a large tertiary referral center. Int J Radiat Oncol Biol Phys 52:351–361
Mac Manus MP et al (2003) Positron emission tomography is superior to computed tomography scanning for response-assessment after radical radiotherapy or chemoradiotherapy in patients with non-small-cell lung cancer. J Clin Oncol 21:1285–1292
MacManus MR et al (2003) FDG-PET-detected extracranial metastasis in patients with non-small cell lung cancer undergoing staging for surgery or radical radiotherapy—survival correlates with metastatic disease burden. Acta Oncol 42:48–54
MacManus M et al (2009) Use of PET and PET/CT for radiation therapy planning: IAEA expert report 2006–2007. Radiother Oncol 91:85–94
Mah K et al (2002) The impact of (18)FDG-PET on target and critical organs in CT-based treatment planning of patients with poorly defined non-small-cell lung carcinoma: a prospective study. Int J Radiat Oncol Biol Phys 52:339–350
Mileshkin L et al (2011) Changes in 18F-fluorodeoxyglucose and 18F-fluorodeoxythymidine position emission tomography imaging in patients with non-small cell lung cancer treated with erlotinib. Clin Cancer Res 17:3304–3315
Munley MT et al (1999) Multimodality nuclear medicine imaging in three-dimensional radiation treatment planning for lung cancer: challenges and prospects. Lung Cancer 23:105–114
Nehmeh SA et al (2002) Effect of respiratory gating on quantifying PET images of lung cancer. J Nucl Med 43:876–881
Nestle U et al (2006) Target volume definition for (18)F-FDG PET-positive lymph nodes in radiotherapy of patients with non-small cell lung cancer. Eur J Nucl Med Mol Imaging 33:263–269
Nestle U et al (1999) 18F-deoxyglucose positron emission tomography (FDG-PET) for the planning of radiotherapy in lung cancer: high impact in patients with atelectasis. Int J Radiat Oncol Biol Phys 44:593–597
Nestle U et al (2005) Comparison of different methods for delineation of 18F-FDG PET-positive tissue for target volume definition in radiotherapy of patients with non-Small cell lung cancer. J Nucl Med 46:1342–1348
Pauleit D et al (2005) PET with O-(2–18F-Fluoroethyl)-l-Tyrosine in peripheral tumors: first clinical results. J Nucl Med 46:411–416
Pommier P et al (2010) Impact of (18)F-FDG PET on treatment strategy and 3D radiotherapy planning in non-small cell lung cancer: A prospective multicenter study. AJR Am J Roentgenol 195:350–355
Reischl G et al (2007) Imaging of tumor hypoxia with [124I]IAZA in comparison with [18F]FMISO and [18F]FAZA–first small animal PET results. J Pharm Pharm Sci 10:203–211
Sasaki M et al (2001) Comparison of MET-PET and FDG-PET for differentiation between benign lesions and malignant tumors of the lung. Ann Nucl Med 15:425–431
Stroobants S, Verschakelen J, Vansteenkiste J (2003) Value of FDG-PET in the management of non-small cell lung cancer. Eur J Radiol 45:49–59
Toloza EM, Harpole L, Detterbeck F, McCrory DC (2003) Invasive staging of non-small cell lung cancer: a review of the current evidence. Chest 123:157S–166S
Townsend DW, Beyer T (2002) A combined PET/CT scanner: the path to true image fusion. Br J Radiol 75(Spec No):S24–S30
van Baardwijk A et al (2007) PET-CT-based auto-contouring in non-small-cell lung cancer correlates with pathology and reduces interobserver variability in the delineation of the primary tumor and involved nodal volumes. Int J Radiat Oncol Biol Phys 68:771–778
van de Steene J et al (2002) Definition of gross tumor volume in lung cancer: inter-observer variability. Radiother Oncol 62:37–49
van Der Wel A et al (2005) Increased therapeutic ratio by 18FDG-PET CT planning in patients with clinical CT stage N2-N3M0 non-small-cell lung cancer: a modeling study. Int J Radiat Oncol Biol Phys 61:649–655
van Loon J et al (2008) 18FDG-PET based radiation planning of mediastinal lymph nodes in limited disease small cell lung cancer changes radiotherapy fields: a planning study. Radiother Oncol 87:49–54
Vanuytsel LJ et al (2000) The impact of (18)F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) lymph node staging on the radiation treatment volumes in patients with non-small cell lung cancer. Radiother Oncol 55:317–324
Wahl RL, Jacene H, Kasamon Y, Lodge MA (2009) From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors. J Nucl Med 50(suppl 1):122S–150S
Wurm RE et al (2006) Image guided respiratory gated hypofractionated stereotactic body radiation therapy (H-SBRT) for liver and lung tumors: initial experience. Acta Oncol 45:881–889
Yaremko B et al (2005) Thresholding in PET images of static and moving targets. Phys Med Biol 50:5969–5982
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Mac Manus, M.P., Hicks, R.J. (2011). PET and PET/CT in Treatment Planning. In: Jeremic, B. (eds) Advances in Radiation Oncology in Lung Cancer. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_300
Download citation
DOI: https://doi.org/10.1007/174_2011_300
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-19924-0
Online ISBN: 978-3-642-19925-7
eBook Packages: MedicineMedicine (R0)