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FDG-PET/CT during concomitant chemo radiotherapy for esophageal cancer: Reducing target volumes to deliver higher radiotherapy doses.
- Source :
-
Acta oncologica (Stockholm, Sweden) [Acta Oncol] 2015 Jun; Vol. 54 (6), pp. 909-15. Date of Electronic Publication: 2014 Nov 24. - Publication Year :
- 2015
-
Abstract
- Background: A planning study investigated whether reduced target volumes defined on FDG-PET/CT during radiotherapy allow total dose escalation without compromising normal tissue tolerance in patients with esophageal cancer.<br />Material and Methods: Ten patients with esophageal squamous cell carcinoma (SCC), candidate to curative-intent concomitant chemo-radiotherapy (CRT), had FDG-PET/CT performed in treatment position, before and during (Day 21) radiotherapy (RT). Four planning scenarios were investigated: 1) 50 Gy total dose with target volumes defined on pre-RT FDG-PET/CT; 2) 50 Gy with boost target volume defined on FDG-PET/CT during RT; 3) 66 Gy with target volumes from pre-RT FDG-PET/CT; and 4) 66 Gy with boost target volume from during-RT FDG-PET/CT.<br />Results: The median metabolic target volume decreased from 12.9 cm3 (minimum 3.7-maximum 44.8) to 5.0 cm3 (1.7-13.5) (p=0.01) between pre- and during-RCT FDG-PET/CT. The median PTV66 was smaller on during-RT than on baseline FDG-PET/CT [108 cm3 (62.5-194) vs. 156 cm3 (68.8-251), p=0.02]. When total dose was set to 50 Gy, planning on during-RT FDG-PET/CT was associated with a marginal reduction in normal tissues irradiation. When total dose was increased to 66 Gy, planning on during-RT PET yielded significantly lower doses to the spinal cord [Dmax=44.1Gy (40.8-44.9) vs. 44.7Gy (41.5-45.0), p=0.007] and reduced lung exposure [V20Gy=23.2% (17.3-27) vs. 26.8% (19.7-30.2), p=0.006].<br />Conclusion: This planning study suggests that adaptive RT based on target volume reduction assessed on FDG-PET/CT during treatment could facilitate dose escalation up to 66 Gy in patients with esophageal SCC.
- Subjects :
- Aged
Aged, 80 and over
Carcinoma, Squamous Cell diagnostic imaging
Carcinoma, Squamous Cell drug therapy
Chemoradiotherapy
Esophageal Neoplasms diagnostic imaging
Esophageal Neoplasms drug therapy
Female
Fluorodeoxyglucose F18
Humans
Lung
Male
Middle Aged
Multimodal Imaging
Organs at Risk
Prospective Studies
Radiation Dosage
Radiopharmaceuticals
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Spinal Cord
Time Factors
Carcinoma, Squamous Cell radiotherapy
Esophageal Neoplasms radiotherapy
Positron-Emission Tomography
Tomography, X-Ray Computed
Subjects
Details
- Language :
- English
- ISSN :
- 1651-226X
- Volume :
- 54
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Acta oncologica (Stockholm, Sweden)
- Publication Type :
- Academic Journal
- Accession number :
- 25417733
- Full Text :
- https://doi.org/10.3109/0284186X.2014.973062