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. 2015 Jan 9:10:11.
doi: 10.1186/s13014-014-0304-5.

Gradient-based delineation of the primary GTV on FLT PET in squamous cell cancer of the thoracic esophagus and impact on radiotherapy planning

Guifang Zhang  1 , Dali Han  2 , Changsheng Ma  3 , Jie Lu  4 , Tao Sun  5 , Tonghai Liu  6 , Jian Zhu  7 , Jingwei Zhou  8 , Yong Yin  9
Affiliations

Gradient-based delineation of the primary GTV on FLT PET in squamous cell cancer of the thoracic esophagus and impact on radiotherapy planning

Guifang Zhang et al. Radiat Oncol. .

Abstract

Background: To validate a gradient-based segmentation method for gross tumor volume(GTV) delineation on (8)F-fluorothymidine (FLT)positron emission tomography (PET)/ computer tomography (CT) in esophageal squamous cell cancer through pathologic specimen, in comparison with standardized uptake values (SUV) threshold-based methods and CT. The corresponding impact of this GTV delineation method on treatment planning was evaluated.

Methods and materials: Ten patients with esophageal squamous cell cancer were enrolled. Before radical surgery, all patients underwent FLT-PET/CT. GTVs were delineated by using four methods. GTVGRAD, GTV1.4 and GTV30%max were segmented on FLT PET using a gradient-based method, a fixed threshold of 1.4 SUV and 30% of SUVmax, respectively. GTVCT was based on CT data alone. The maximum longitudinal tumor length of each segmented GTV was compared with the measured tumor length of the pathologic gross tumor length (LPath). GTVGRAD, GTV1.4 and GTV30%max were compared with GTVCT by overlap index. Two radiotherapy plannings (planGRAD) and (planCT) were designed for each patient based on GTVGRAD and GTVCT. The dose-volume parameters for target volume and normal tissues, CI and HI of planGRAD and planCT were compared.

Results: The mean ± standard deviation of LPath was 6.47 ± 2.70 cm. The mean ± standard deviation of LGRAD,L1.4, L30%max and LCT were 6.22 ± 2.61, 6.23 ± 2.80, 5.95 ± 2.50,7.17 ± 2.28 cm, respectively. The Pearson correlation coefficients between LPath and each segmentation method were 0.989, 0.920, 0.920 and 0.862, respectively. The overlap indices of GTVGRAD, GTV1.4, GTV30%max when compared with GTVCT were 0.75 ± 0.12, 0.71 ± 0.12, 0.57 ± 0.10, respectively. The V5, V10, V20, V30 and mean dose of total-lung,V30 and mean dose of heart of planGRAD were significantly lower than planCT.

Conclusions: The gradient-based method provided the closest estimation of target length. The radiotherapy plannings based on the gradient-based segmentation method reduced the irradiated volume of lung, heart in comparison to CT.

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Figures

Figure 1
Figure 1
Overview of the tumor delineation for one patient with middle thoracic esophageal cancer. (A) Gross tumor lengths delineated on CT images by different methods. (B) Gross tumor lengths delineated on FLT PET/CT images by different methods. Volumes are displayed in transaxial, sagittal and coronal planes. Purple, orange, blue and Red contours illustrate different parameters (e.g. GRAD, 1.4 SUV threshold, 30% of SUVmax and CT).
Figure 2
Figure 2
Treatment planning simulated with FLTPET/CT for 67-years-old female patient with middle thoracic esophageal cancer. (A) FLT PET/CT-based five-beam conformal radiation therapy (B) CT-based five-beam conformal radiation therapy.
Figure 3
Figure 3
The mean Length obtained using different methods. Error bars indicate standard deviation.
Figure 4
Figure 4
The mean volume obtained using different methods. Error bars indicate standard deviation.
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