18FDG-PET based radiation planning of mediastinal lymph nodes in limited disease small cell lung cancer changes radiotherapy fields: A planning study

van Loon, Judith; Offermann, Claudia; Bosmans, Geert; Wanders, Rinus; Dekker, André; Borger, Jacques; Oellers, Michel; Dingemans, Anne-Marie; van Baardwijk, Angela; Teule, Jaap; Snoep, Gabriel; Hochstenbag, Monique; Houben, Ruud; Lambin, Philippe; De Ruysscher, Dirk

doi:10.1016/j.radonc.2008.02.019

« Previous Next »Radiotherapy & Oncology
Volume 87, Issue 1 , Pages 49-54, April 2008

¹⁸FDG-PET based radiation planning of mediastinal lymph nodes in limited disease small cell lung cancer changes radiotherapy fields: A planning study

Judith van Loon
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, University Hospital Maastricht, The Netherlands
- Corresponding author. Judith van Loon, MAASTRO Clinic, Dr. Tanslaan 12, NL-6229 ET Maastricht, The Netherlands.
Claudia Offermann
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, University Hospital Maastricht, The Netherlands
Geert Bosmans
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, University Hospital Maastricht, The Netherlands
Rinus Wanders
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, University Hospital Maastricht, The Netherlands
André Dekker
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, University Hospital Maastricht, The Netherlands
Jacques Borger
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, University Hospital Maastricht, The Netherlands
Michel Oellers
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, University Hospital Maastricht, The Netherlands
Anne-Marie Dingemans
- Department of Pulmonology, University Hospital Maastricht, The Netherlands
Angela van Baardwijk
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, University Hospital Maastricht, The Netherlands
Jaap Teule
- Department of Nuclear Medicine, University Hospital Maastricht, The Netherlands
Gabriel Snoep
- Department of Radiology, University Hospital Maastricht, The Netherlands
Monique Hochstenbag
- Department of Pulmonology, University Hospital Maastricht, The Netherlands
Ruud Houben
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, University Hospital Maastricht, The Netherlands
Philippe Lambin
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, University Hospital Maastricht, The Netherlands
Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, University Hospital Maastricht, The Netherlands

Received 11 October 2007; received in revised form 12 February 2008; accepted 16 February 2008. published online 17 March 2008.

Abstract

Background and purpose

To investigate the influence of selective irradiation of ¹⁸FDG-PET positive mediastinal nodes on radiation fields and normal tissue exposure in limited disease small cell lung cancer (LD-SCLC).

Material and methods

Twenty-one patients with LD-SCLC, of whom both CT and PET images were available, were studied. For each patient, two three-dimensional conformal treatment plans were made with selective irradiation of involved lymph nodes, based on CT and on PET, respectively. Changes in treatment plans as well as dosimetric factors associated with lung and esophageal toxicity were analyzed and compared.

Results

FDG-PET information changed the treatment field in 5 patients (24%). In 3 patients, this was due to a decrease and in 2 patients to an increase in the number of involved nodal areas. However, there were no significant differences in gross tumor volume (GTV), lung, and esophageal parameters between CT- and PET-based plans.

Conclusions

Incorporating FDG-PET information in radiotherapy planning for patients with LD-SCLC changed the treatment plan in 24% of patients compared to CT. Both increases and decreases of the GTV were observed, theoretically leading to the avoidance of geographical miss or a decrease of radiation exposure of normal tissues, respectively. Based on these findings, a phase II trial, evaluating PET-scan based selective nodal irradiation, is ongoing in our department.

Keywords: Limited disease small cell lung cancer, Radiotherapy, PET, Planning study