Pierpaolo Alongi1, Riccardo Laudicella2, Isacco Desideri3, Agostino Chiaravalloti4, Paolo Borghetti5, Natale Quartuccio6, Michele Fiore7, Laura Evangelista8, Lorenza Marino9, Federico Caobelli10, Carmelo Tuscano11, Paola Mapelli12, Valentina Lancellotta13, Salvatore Annunziata14, Maria Ricci15, Elisa Ciurlia16, Alba Fiorentino17. 1. Department of Radiological Sciences, Nuclear Medicine Service, Fondazione Istituto G. Giglio, Cefalu. Italy. 2. Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina. Italy. 3. Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Italy. 4. IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy. 5. Radiation Oncology Department University and Spedali Civili, Brescia, Italy. 6. Nuclear Medicine Unit, ARNAS Civico Palermo, Palermo, Italy. 7. Radiation Oncology, Campus Bio-Medico University, Rome, Italy. 8. Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy. 9. Radiotherapy Oncology Department, REM, Viagrande, Catania, Italy. 10. Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland. 11. Radiotherapy Oncology Department, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy. 12. Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy. 13. Radiation Oncology Section, University of Perugia, Italy. 14. Fondazione Policlinico A. Gemelli IRCCS-Università Cattolica Sacro Cuore, Roma, Italy. 15. Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy. 16. Radiotherapy Oncology Department, Vito Fazzi Hospital, Lecce, Italy. 17. Radiotherapy Oncology Department, General Regional Hospital "F. Miulli", Strada Prov. 127 Km 4, 70021, Acquaviva delle Fonti, Bari, Italy. Electronic address: albafiorentino@hotmail.it.
Abstract
AIM: Functional and molecular imaging, including positron emission tomography with computed tomography imaging (PET/CT) is increasing for radiotherapy (RT) definition of the target volume. This expert review summarizes existing data of functional imaging modalities and RT management, in terms of target volume delineation, for the following anatomical districts: brain (for primary and secondary tumors), head/neck and lung. MATERIALS AND METHODS: A collection of available published data was made, by PubMed a search. Only original articles were carefully and critically revised. RESULTS: For primary and secondary brain tumors, amino acid PET radiotracers could be useful to identify microscopic residual areas and to differ between recurrence and treatment-related alterations in case of re-irradiation. As for head and neck neoplasms may benefit from precise PET/CT-based target delineation, due to the major capability to identify high-risk RT areas. In primary and secondary lung cancer, PET/CT could be useful both to delimit a tumor and collapsed lungs and as a predictive parameter of treatment response. CONCLUSION: Taken together, molecular and functional imaging approaches offer a major step to individualize radiotherapeutic care going forward. Nevertheless, several uncertainties remain on the standard method to properly assess the target volume definition including PET information for primary and secondary brain tumors.
AIM: Functional and molecular imaging, including positron emission tomography with computed tomography imaging (PET/CT) is increasing for radiotherapy (RT) definition of the target volume. This expert review summarizes existing data of functional imaging modalities and RT management, in terms of target volume delineation, for the following anatomical districts: brain (for primary and secondary tumors), head/neck and lung. MATERIALS AND METHODS: A collection of available published data was made, by PubMed a search. Only original articles were carefully and critically revised. RESULTS: For primary and secondary brain tumors, amino acid PET radiotracers could be useful to identify microscopic residual areas and to differ between recurrence and treatment-related alterations in case of re-irradiation. As for head and neck neoplasms may benefit from precise PET/CT-based target delineation, due to the major capability to identify high-risk RT areas. In primary and secondary lung cancer, PET/CT could be useful both to delimit a tumor and collapsed lungs and as a predictive parameter of treatment response. CONCLUSION: Taken together, molecular and functional imaging approaches offer a major step to individualize radiotherapeutic care going forward. Nevertheless, several uncertainties remain on the standard method to properly assess the target volume definition including PET information for primary and secondary brain tumors.