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Clinical PET-CT in Radiology pp 157–162Cite as

Principles of PET in Cancer Treatment for the Assessment of Chemotherapy and Radiotherapy Response and for Radiotherapy Treatment Planning

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Abstract

Inclusion of PET images to guide radiotherapy planning has advantages. Definition of target volumes of areas equivocal for malignancy can be done with greater certainty, but depends on sensitivity and specificity at that site. There is a huge potential for biologic dose planning using intensity-modulated radiation therapy (IMRT), which will expand with the development of new tracers. However, only one published study demonstrates a survival benefit from incorporating PET into treatment planning. Further clinical studies and outcome analysis are required to evaluate cost effectiveness and overall utility before a change in practice can be recommended. For current radiotherapy treatment planning, PET images are best used as a guide alongside CT images and should be done so with caution.

PET is a functional imaging tool that provides quantitative, repeatable, and sensitive 3D data. There has been increased availability and uptake of PET and PET-CT in cancer diagnosis and management over recent years. This has implications not only for staging, response assessment, and radiotherapy treatment planning, but also for tumor phenotyping and predictive testing.

The commonest tracer used for routine PET scanning is the glucose analogue, 18F-Fluorodeoxyglucose (FDG). Wahrburg demonstrated several decades ago that cancer cells had higher rates of glucose uptake compared to normal cells. Thus, when the tracer FDG is administered, it accumulates preferentially in malignant cells, so increasing the signal given by tumor compared to normal tissue. Glucose uptake and metabolism are dependent on the glucose transporter Glut-1, which facilitates glucose uptake into cells and hexokinase enzymes, which irreversibly phosphorylate cellular glucose, trapping it within the cell. Increased uptake of FDG indicates a likelihood of disease presence, but is not an absolute measure.

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Authors and Affiliations

  1. Wolfson Molecular Imaging Centre, University of Manchester, 15 Grosvenor Place, Ashton Preston, Lancs, PR2 1ED, United Kingdom

    Natalie Charnley

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  1. Natalie Charnley
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  2. Terry Jones
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  3. Pat Price
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Correspondence to Natalie Charnley .

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Editors and Affiliations

  1. Advanced Radiology Services, North Evergreen Drive 3264, Grand Rapids, 49525, Michigan, USA

    Paul Shreve

  2. , Head, PET and SPECT Development, Singapore Bioimaging Consortium, 11 Biopolis Way #02-02 Hel, Singapore, 138667, Singapur, Singapore

    David W. Townsend

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Charnley, N., Jones, T., Price, P. (2011). Principles of PET in Cancer Treatment for the Assessment of Chemotherapy and Radiotherapy Response and for Radiotherapy Treatment Planning. In: Shreve, P., Townsend, D. (eds) Clinical PET-CT in Radiology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-48902-5_15

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  • DOI: https://doi.org/10.1007/978-0-387-48902-5_15

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