Stephanie A Terezakis1, Heiko Schöder2, Alexander Kowalski3, Patrick McCann3, Remy Lim2, Alla Turlakov2, Mithat Gonen4, Chris Barker3, Anuj Goenka3, Shona Lovie3, Joachim Yahalom5. 1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland. 2. Department of Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York. 3. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York. 4. Department of Statistics, Memorial Sloan-Kettering Cancer Center, New York, New York. 5. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: yahalomj@mskcc.org.
Abstract
PURPOSE: This prospective single-institution study examined the impact of positron emission tomography (PET) with the use of 2-[(18)F] fluoro-2-deoxyglucose and computed tomography (CT) scan radiation treatment planning (TP) on target volume definition in lymphoma. METHODS AND MATERIALS: 118 patients underwent PET/CT TP during June 2007 to May 2009. Gross tumor volume (GTV) was contoured on CT-only and PET/CT studies by radiation oncologists (ROs) and nuclear medicine physicians (NMPs) for 95 patients with positive PET scans. Treatment plans and dose-volume histograms were generated for CT-only and PET/CT for 95 evaluable sites. Paired t test statistics and Pearson correlation coefficients were used for analysis. RESULTS: 70 (74%) patients had non-Hodgkin lymphoma, 10 (11%) had Hodgkin lymphoma, 12 (10%) had plasma-cell neoplasm, and 3 (3%) had other hematologic malignancies. Forty-three (45%) presented with relapsed/refractory disease. Forty-five (47%) received no prior chemotherapy. The addition of PET increased GTV as defined by ROs in 38 patients (median, 27%; range, 5%-70%) and decreased GTV in 41 (median, 39.5%; range, 5%-80%). The addition of PET increased GTV as defined by NMPs in 27 patients (median, 26.5%; range, 5%-95%) and decreased GTV in 52 (median, 70%; range, 5%-99%). The intraobserver correlation between CT-GTV and PET-GTV was higher for ROs than for NMPs (0.94, P<.01 vs 0.89, P<.01). On the basis of Bland-Altman plots, the PET-GTVs defined by ROs were larger than those defined by NMPs. On evaluation of clinical TPs, only 4 (4%) patients had inadequate target coverage (D95 <95%) of the PET-GTV defined by NMPs. CONCLUSIONS: Significant differences between the RO and NMP volumes were identified when PET was coregistered to CT for radiation planning. Despite this, the PET-GTV defined by ROs and NMPs received acceptable prescription dose in nearly all patients. However, given the potential for a marginal miss, consultation with an experienced PET reader is highly encouraged when PET/CT volumes are delineated, particularly for questionable lesions and to assure complete and accurate target volume coverage.
PURPOSE: This prospective single-institution study examined the impact of positron emission tomography (PET) with the use of 2-[(18)F] fluoro-2-deoxyglucose and computed tomography (CT) scan radiation treatment planning (TP) on target volume definition in lymphoma. METHODS AND MATERIALS: 118 patients underwent PET/CT TP during June 2007 to May 2009. Gross tumor volume (GTV) was contoured on CT-only and PET/CT studies by radiation oncologists (ROs) and nuclear medicine physicians (NMPs) for 95 patients with positive PET scans. Treatment plans and dose-volume histograms were generated for CT-only and PET/CT for 95 evaluable sites. Paired t test statistics and Pearson correlation coefficients were used for analysis. RESULTS: 70 (74%) patients had non-Hodgkin lymphoma, 10 (11%) had Hodgkin lymphoma, 12 (10%) had plasma-cell neoplasm, and 3 (3%) had other hematologic malignancies. Forty-three (45%) presented with relapsed/refractory disease. Forty-five (47%) received no prior chemotherapy. The addition of PET increased GTV as defined by ROs in 38 patients (median, 27%; range, 5%-70%) and decreased GTV in 41 (median, 39.5%; range, 5%-80%). The addition of PET increased GTV as defined by NMPs in 27 patients (median, 26.5%; range, 5%-95%) and decreased GTV in 52 (median, 70%; range, 5%-99%). The intraobserver correlation between CT-GTV and PET-GTV was higher for ROs than for NMPs (0.94, P<.01 vs 0.89, P<.01). On the basis of Bland-Altman plots, the PET-GTVs defined by ROs were larger than those defined by NMPs. On evaluation of clinical TPs, only 4 (4%) patients had inadequate target coverage (D95 <95%) of the PET-GTV defined by NMPs. CONCLUSIONS: Significant differences between the RO and NMP volumes were identified when PET was coregistered to CT for radiation planning. Despite this, the PET-GTV defined by ROs and NMPs received acceptable prescription dose in nearly all patients. However, given the potential for a marginal miss, consultation with an experienced PET reader is highly encouraged when PET/CT volumes are delineated, particularly for questionable lesions and to assure complete and accurate target volume coverage.
Authors: Heiko Schöder; Ariela Noy; Mithat Gönen; Lijun Weng; David Green; Yusuf E Erdi; Steven M Larson; Henry W D Yeung Journal: J Clin Oncol Date: 2005-04-18 Impact factor: 44.544
Authors: Lena Specht; Joachim Yahalom; Tim Illidge; Anne Kiil Berthelsen; Louis S Constine; Hans Theodor Eich; Theodore Girinsky; Richard T Hoppe; Peter Mauch; N George Mikhaeel; Andrea Ng Journal: Int J Radiat Oncol Biol Phys Date: 2013-06-18 Impact factor: 7.038
Authors: Stephanie A Terezakis; Margie A Hunt; Alexander Kowalski; Patrick McCann; C Ross Schmidtlein; Anne Reiner; Mithat Gönen; Assen S Kirov; Anne Marie Gonzales; Heiko Schöder; Joachim Yahalom Journal: Int J Radiat Oncol Biol Phys Date: 2010-10-08 Impact factor: 7.038
Authors: Tomas Kazda; Deanna H Pafundi; Alan Kraling; Thomas Bradley; Val J Lowe; Debra H Brinkmann; Nadia N Laack Journal: Phys Imaging Radiat Oncol Date: 2018-06-22