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. 2008 Oct;89(1):13-8.
doi: 10.1016/j.radonc.2008.05.021. Epub 2008 Jun 12.

Correlation between pretreatment FDG-PET biological target volume and anatomical location of failure after radiation therapy for head and neck cancers

Daniel E Soto  1 , Marc L Kessler, Morand Piert, Avraham Eisbruch
Affiliations

Correlation between pretreatment FDG-PET biological target volume and anatomical location of failure after radiation therapy for head and neck cancers

Daniel E Soto et al. Radiother Oncol. 2008 Oct.

Abstract

Background and purpose: To assess whether the pretreatment FDG-PET-defined biologic target volume (PET-BTV) correlates with the anatomical sites of loco-regional failure (LRF) after RT for head and neck cancer (HNC).

Materials and methods: We retrospectively identified 61 HNC patients treated definitively with either 3-D CRT or IMRT who had a pre-therapy PET/CT. The GTV and high-risk CTV(1) definitions included composite data obtained from diagnostic CT, PET/CT, physical examination, and MRI when available. The median CTV(1) dose was 70Gy. 95% received chemotherapy. For patients with LRF, a recurrence volume (V(r)) was identified and was mapped to the pretreatment planning CT and pretreatment PET scan.

Results: At a median follow-up of 22 months, 15% (9/61) patients had LRF. For patients with a LRF, 100% (9/9) of failures were inside the GTV. One of nine [11% (95% CI: 3-45%)] had V(r) which mapped outside of the pretreatment PET-BTV, while 8/9 patients had V(r) within the PET-BTV. Predictors of LRF in our series included GTV volume (p=0.003), but not mean SUV (p=0.13) or max SUV (p=0.25).

Conclusions: Following treatment in which the GTV was defined based on the composite of imaging and physical examination, the majority, but not all, LRF occurred within the PET-BTV. These results support an important, but not exclusive, role of FDG-PET in defining the GTV.

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Figures

Figure 1
Figure 1. In-field recurrence (Vr) outside of PET-BTV
a) Pretreatment PETCT (CT data set not shown). Vr mapped in black from registered failure scan. Failure scan was rigidly registered after using mandibles. Mandible from failure scan is outlined in brown. b) IMRT treatment planning CT scan. Targets: PTV 70Gy is pink, PTV 64Gy is green, & PTV 60Gy is blue. 70Gy iso dose line (IDL) is in yellow & 60Gy IDL is in fuchsia. Vr is black. C) Failure CT scan with Vr in black.
Figure 2
Figure 2. In-field recurrence (Vr) within PET-BTV
a) Pretreatment PET-CT (CT data set not shown). Vr mapped in pink from registered failure scan. b) IMRT treatment planning CT scan. Targets: PTV 70Gy is pink, PTV 50Gy is light blue. 68%Gy iso dose line (IDL) is in yellow & 48Gy IDL is in fuchsia. Vr is dark blue. C) Failure CT scan with Vr in pink.
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