Journal article
FDG-PET/CT-guided intensity modulated head and neck radiotherapy: A pilot investigation
Head & neck, Vol.27(6), pp.478-487
06/2005
DOI: 10.1002/hed.20177
PMID: 15772953
Abstract
<p>Background. 2-deoxy-2[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) imaging can be registered with CT images and can potentially improve neck staging sensitivity and specificity in patients with head and neck squamous cell cancer. The intent of this study was to examine the use of registered FDG-PET/CT imaging to guide head and neck intensity modulated radiotherapy (IMRT) planning.</p><p>Methods. Twenty patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx underwent FDG-PET and contrast-enhanced CT imaging of the head and neck before neck dissection surgery, Combined FDG-PET/CT images were created by use of a nonrigid image registration algorithm. All IMRT plans were theoretical and were not used for treatment. We prescribed 66 Gy in 30 fractions to FDG-avid CT abnormalities and nodal zones directly involved with disease, without prophylactic coverage of uninvolved neck levels. Matched CT-guided IMRT plans designed according to the specifications of Radiation Therapy Oncology Group (RTOG) H-0022 were available for comparison. We investigated the feasibility of FDG-PET/CT-directed IMRT dose escalation in five patients with FDG-avid disease located away from critical normal structures. After 66 Gy, FDG-avid disease with 0.5-cm margins was boosted in 220 cGy increments until dose-limiting criteria were reached.</p><p>Results. Elimination of prophylactic coverage to FDG-PET/CT-negative neck levels markedly reduced mean dose (Dmean) to the contralateral parotid gland (p < .001) and Dmean to the laryngeal cartilage (p = .001). No FDG-PET/CT-directed plan missed pathologically verified nodal disease. During the dose escalation exercise, we successfully increased the dose to 95% of the planning target volume (PTV95%) to a mean of 7490 cGy (range, 7153-8098 cGy).</p><p>Conclusions. We demonstrate early proof of the principle that FDG-PET/CT-guided IMRT planning can selectively target and intensify treatment of head and neck disease while reducing critical normal tissue doses. Routine clinical use of such planning should not be engaged until the accuracy of FDG-PET/CT is fully validated. Future directions, including refinement of treatment to gross disease and radiologically uninvolved neck nodal levels, are discussed. (c) 2005 Wiley Periodicals, Inc.</p>
Details
- Title: Subtitle
- FDG-PET/CT-guided intensity modulated head and neck radiotherapy: A pilot investigation
- Creators
- David L. Schwartz - University of WashingtonEric C. Ford - University of WashingtonJoseph Rajendran - University of WashingtonBevan Yueh - University of WashingtonMarc D. Coltrera - University of WashingtonJeffery Virgin - VA Puget Sound Health Care SystemYoshimi Anzai - University of WashingtonDavid Haynor - University of WashingtonBarbara Lewellen - University of WashingtonDavid Mattes - University of WashingtonPaul Kinahan - University of WashingtonJuergen Meyer - University of WashingtonMark Phillips - University of WashingtonMichael LeBlanc - University of WashingtonKenneth Krohn - University of WashingtonJanet Eary - University of WashingtonGeorge E. Laramore - University of Washington
- Resource Type
- Journal article
- Publication Details
- Head & neck, Vol.27(6), pp.478-487
- DOI
- 10.1002/hed.20177
- PMID
- 15772953
- NLM abbreviation
- Head Neck
- ISSN
- 1043-3074
- eISSN
- 1097-0347
- Publisher
- Wiley Subscription Services, Inc., A Wiley Company; HOBOKEN
- Number of pages
- 10
- Language
- English
- Date published
- 06/2005
- Academic Unit
- Otolaryngology
- Record Identifier
- 9984966858202771
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