Purpose: The aim of this study was to evaluate the possible role of fused images (anatomical CT and functional FDG-PET), acquired with a combined PET-CT scanner, in delineating gross tumour volume (GTV) and clinical target volume (CTV).
Materials and Methods: Twenty-nine patients with small cell or non-small cell lung cancer were studied. CT and FDG-PET images were obtained in treatment position in a combined PET/CT scanner. FDG-PET and CT images were transferred to a workstation for contouring. Gross Tumor Volumes (GTV) and Clinical Target Volumes (CTV) were defined first using the CT data alone and then using the registered CT and FDG-PET data. For each patients two three Dimensional Conformal Radiotherapy (3DCRT) plans were made and they were compared with respect to the GTV, CTV, mean lung dose and volume of normal lung receiving ≥20 Gy (Vlung20Gy)
Results: Out of these 29 patients, PET clearly changed GTV in 17 patients. PET increased CTV in 7 patients. Additional unsuspected regional nodal disease was included in these patients. In 16 patients with atelectasis, decrease in CTV led to reduced radiation dose to the lung. Likewise, with additional PET information, CTV was enlarged and values of MLD and Vlung20Gy were increased in 5 patients.
Conclusion: The use of PET/CT images in radiotherapy is helpful in defining tumor location more precisely, possibly sparing more normal lung tissues and also helpful in differentiating tumor from atelectasis lung. The increasing availability of combined PET/CT units will facilitate the use of this technology for radiation treatment planning.
Keywords— Lung Cancer, Image Fusion, PET/CT, Target Definition, Treatment Planning.
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