Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov;200(11):931-941.
doi: 10.1007/s00066-024-02260-4. Epub 2024 Aug 9.

Implementation of PET/CT in radiation oncology-a patterns-of-care analysis of the German Society of Nuclear Medicine and the German Society of Radiation Oncology

Simone Wegen  1   2 , Ursula Nestle  3   4 , Constantinos Zamboglou  4 , Simon K B Spohn  4   5 , Nils Henrik Nicolay  6 , Lena M Unterrainer  7 , Stefan A Koerber  8   9 , Christian La Fougère  10 , Emmanouil Fokas  11   12 , Carsten Kobe  13   14 , Chukwuka Eze  15 , Anca-Ligia Grosu  4   5 , Wolfgang P Fendler  16   14 , Adrien Holzgreve  7   14 , Rudolf Werner  17 , Nina-Sophie Schmidt-Hegemann  15
Affiliations

Implementation of PET/CT in radiation oncology-a patterns-of-care analysis of the German Society of Nuclear Medicine and the German Society of Radiation Oncology

Simone Wegen et al. Strahlenther Onkol. 2024 Nov.

Abstract

Background: The use of positron-emission tomography (PET)/computed tomography (CT) in radiation therapy (RT) has increased. Radiation oncologists (RadOncs) have access to PET/CT with a variety of tracers for different tumor entities and use it for target volume definition. The German Society of Nuclear Medicine (DGN) and the German Society of Radiation Oncology (DEGRO) aimed to identify current patterns of care in order to improve interdisciplinary collaboration.

Methods: We created an online survey on participating RadOncs' use of PET tracers for different tumor entities and how they affect RT indication, dose prescription, and target volume definition. Further topics were reimbursement of PET/CT and organizational information (fixed timeslots and use of PET with an immobilization device [planning/RT-PET]). The survey contained 31 questions in German language (yes/no questions, multiple choice [MC] questions, multiple select [MS] questions, and free-text entry options). The survey was distributed twice via the DEGRO member mailing list.

Results: During the survey period (May 22-August 7, 2023) a total of 156 RadOncs (13% of respondents) answered the survey. Among these, 59% reported access to diagnostic PET/CT within their organization/clinic and 24% have fixed timeslots for their patients. 37% of survey participants can perform RT-PET and 29% have the option of providing a dedicated RT technician for planning PET. Besides [18F]-fluorodeoxyglucose (FDG; mainly used in lung cancer: 95%), diagnostic prostate-specific membrane antigen (PSMA)-PET/CT for RT of prostate cancer is routinely used by 44% of participants (by 64% in salvage RT). Use of amino acid PET in brain tumors and somatostatin receptor PET in meningioma is low (19 and 25%, respectively). Scans are reimbursed through private (75%) or compulsory (55%) health insurance or as part of indications approved by the German Joint Federal Committee (Gemeinsamer Bundesausschuss; 59%). 98% of RadOncs agree that PET impacts target volume definition and 62% think that it impacts RT dose prescription.

Discussion: This is the first nationwide survey on the role of PET/CT for RT planning among RadOncs in Germany. We find high acceptance of PET results for treatment decisions and target volume definition. Planning PET comes with logistic challenges for different healthcare settings (e.g., private practices vs. university hospitals). The decision to request PET/CT is often based on the possibility of reimbursement.

Conclusion: PET/CT has become an important tool for RadOncs, with several indications. However, access is still limited at several sites, especially for dedicated RT-PET. This study aims to improve interdisciplinary cooperation and adequate implementation of current guidelines for the treatment of various tumor entities.

Keywords: Germany; PET/CT; Planning PET; Reimbursement; Survey.

PubMed Disclaimer

Conflict of interest statement

L.M. Unterrainer discloses personal fees (speaker honorary and/or advisory boards fees) from Astellas Pharma Inc., Novartis Radiopharmaceuticals, Telix-Pharmaceuticals, and ABX Radiopharmaceuticals. LMU is supported by the Clinician Scientist Program of the LMU Munich. W.P. Fendler reports fees from SOFIE Bioscience (research funding), Janssen (consultant, speaker), Calyx (consultant, image review), Bayer (consultant, speaker, research funding), Novartis (speaker, consultant), Telix (speaker), GE Healthcare (speaker), Eczacıbaşı Monrol (speaker), Abx (speaker), Amgen (speaker), and Urotrials (speaker) outside of the submitted work. S. Wegen, U. Nestle, C. Zamboglou, S.K.B. Spohn, N.H. Nicolay, S.A. Koerber, C. La Fougère, E. Fokas, C. Kobe, C. Eze, A.-L. Grosu, A. Holzgreve, R. Werner and N.-S. Schmidt-Hegemann declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Use of FDG PET. a Statement 1: “In the practice/clinic/hospital I work at, I can request FDG PET/CT as a diagnostic tool prior to radiotherapy.” Statement 2: “In the practice/clinic/hospital I work at, I can request FDG PET/CT as planning PET/CT (in RT position, with presence of a medical radiation technologist) prior to radiotherapy.” Likert scale, divided by working place; b FDG PET/CT requested by RadOncs in the diagnostic setting (yellow) and for RT planning (blue) according to different tumor entities
Fig. 2
Fig. 2
Use of PSMA PET. a Statement 1: “In the practice/clinic/hospital I work at, I can request PSMA PET/CT as a diagnostic tool prior to radiotherapy.” Statement 2: “In the practice/clinic/hospital I work at, I can request PSMA PET/CT as a planning PET/CT (in RT positioning, with the presence of a medical radiation technologist) prior to radiotherapy.” Likert scale, divided by working place; b PSMA PET/CT (diagnostic and planning) requested according to prostate cancer tumor stage
Fig. 3
Fig. 3
Access to PET/CT stratified by working place. Q22: “I have access to PET/CT within my department/practice network/clinic/university hospital.” Participants answering “yes”: blue part of the column; “no”: no data, grey; see also Table 2
See this image and copyright information in PMC

References

    1. Lapa C, Nestle U, Albert NL, Baues C, Beer A, Buck A et al (2021) Value of PET imaging for radiation therapy. Strahlenther Onkol 197:1–23. 10.1007/s00066-021-01812-2 - PubMed
    1. Lapa C, Nestle U, Albert NL, Baues C, Beer A, Buck A et al (2021) Value of PET imaging for radiation therapy. Nuklearmedizin 60:326–343. 10.1055/a-1525-7029 - PubMed
    1. Nestle U, Schimek-Jasch T, Kremp S, Schaefer-Schuler A, Mix M, Kusters A et al (2020) Imaging-based target volume reduction in chemoradiotherapy for locally advanced non-small-cell lung cancer (PET-Plan): a multicentre, open-label, randomised, controlled trial. Lancet Oncol 21:581–592. 10.1016/S1470-2045(20)30013-9 - PubMed
    1. Fendler WP, Calais J, Eiber M, Flavell RR, Mishoe A, Feng FY et al (2019) Assessment of 68ga-PSMA-11 PET accuracy in localizing recurrent prostate cancer: a prospective single-arm clinical trial. JAMA Oncol 5:856–863. 10.1001/jamaoncol.2019.0096 - PMC - PubMed
    1. Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P et al (2020) Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet 395:1208–1216. 10.1016/S0140-6736(20)30314-7 - PubMed

MeSH terms