AIM: To compare radiotherapy plans made according to CT and PET/CT and to investigate the impact of changes in target volumes on tumour control probability (TCP), normal tissue complication probability (NTCP) and the impact of PET/CT on the staging and treatment strategy. BACKGROUND: Contemporary studies have proven that PET/CT attains higher sensitivity and specificity in the diagnosis of lung cancer and also leads to higher accuracy than CT alone in the process of target volume delineation in NSCLC. MATERIALS AND METHODS: Between October 2009 and March 2012, 31 patients with locally advanced NSCLC, who had been referred to radical radiotherapy were involved in our study. They all underwent planning PET/CT examination. Then we carried out two separate delineations of target volumes and two radiotherapy plans and we compared the following parameters of those plans: staging, treatment purpose, the size of GTV and PTV and the exposure of organs at risk (OAR). TCP and NTCP were also compared. RESULTS: PET/CT information led to a significant decrease in the sizes of target volumes, which had the impact on the radiation exposure of OARs. The reduction of target volume sizes was not reflected in the significant increase of the TCP value. We found that there is a very strong direct linear relationship between all evaluated dosimetric parameters and NTCP values of all evaluated OARs. CONCLUSIONS: Our study found that the use of planning PET/CT in the radiotherapy planning of NSCLC has a crucial impact on the precise determination of target volumes, more precise staging of the disease and thus also on possible changes of treatment strategy.

Department of Imaging Methods University Hospital in Pilsen alej Svobody 80 304 60 Pilsen Czech Republic

Department of Mathematics and Statistics Faculty of Science Masaryk University in Brno Kotlářská 2 611 37 Brno Czech Republic

Department of Oncology and Radiotherapy University Hospital in Pilsen alej Svobody 80 304 60 Pilsen Czech Republic

Department of Radiation Oncology Masaryk Memorial Cancer Institute in Brno Žlutý kopec 543 7 602 00 Brno Czech Republic

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Vojtisek R., Havranek K., Finek J. The use of PET/CT fusion in radiotherapy treatment planning of non-small-cell lung cancers. Klin Onkol. 2011;24(1):23–34. PubMed

Lardinois D., Weder W., Hany T.F. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003;348(25):2500–2507. PubMed

Sause W., Kolesar P., Taylor S.I.V. Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer: Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. Chest. 2000;117(February (2)):358–364. PubMed

Belani C.P., Wang W., Johnson D.H. Phase III study of the Eastern Cooperative Oncology Group (ECOG 2597): induction chemotherapy followed by either standard thoracic radiotherapy or hyperfractionated accelerated radiotherapy for patients with unresectable stage IIIA and B non-small-cell lung cancer. J Clin Oncol. 2005;23(June (16)):3760–3767. PubMed

Baumann M., Herrmann T., Koch R. Final results of the randomized phase III CHARTWEL-trial (ARO 97-1) comparing hyperfractionated-accelerated versus conventionally fractionated radiotherapy in non-small cell lung cancer (NSCLC) Radiother Oncol. 2011;100(July (1)):76–85. PubMed

Soliman M., Yaromina A., Appold S. GTV differentially impacts locoregional control of non-small cell lung cancer (NSCLC) after different fractionation schedules: subgroup analysis of the prospective randomized CHARTWEL trial. Radiother Oncol. 2013;106(March (3)):299–304. PubMed

De Ruysscher D., Wanders S., Minken A. Effects of radiotherapy planning with a dedicated combined PET-CT-simulator of patients with non-small cell lung cancer on dose limiting normal tissues and radiation dose-escalation: a planning study. Radiother Oncol. 2005;77(October (1)):5–10. PubMed

ICRU Report 50 . International Commission for Radiation Units and Measurements; Bethesda: 1993. Prescribing, recording and reporting photon beam therapy; p. 71.

ICRU Report 62 . International Commission for Radiation Units and Measurements; Bethesda: 1999. Prescribing, recording and reporting photon beam therapy (Suppl. to ICRU Report 50) p. 52.

Biehl K.J., Kong F.M., Dehdashti F. 18F-FDG PET definition of gross tumor volume for radiotherapy of non-small cell lung cancer: is a single standardized uptake value threshold approach appropriate? J Nucl Med. 2006;47(November (11)):1808–1812. PubMed

Senan S., Burgers S., Samson M.J. Can elective nodal irradiation be omitted in stage III non-small-cell lung cancer? Analysis of recurrences in a phase II study of induction chemotherapy and involved-field radiotherapy. Int J Radiat Oncol Biol Phys. 2002;54(November (4)):999–1006. PubMed

Klopp A.H., Chang J.Y., Tucker S.L. Intrathoracic patterns of failure for non-small-cell lung cancer with positron-emission tomography/computed tomography-defined target delineation. Int J Radiat Oncol Biol Phys. 2007;69(December (5)):1409–1416. PubMed

Sura S., Greco C., Gelblum D., Yorke E.D., Jackson A., Rosenzweig K.E. (18)F-fluorodeoxyglucose positron emission tomography-based assessment of local failure patterns in non-small-cell lung cancer treated with definitive radiotherapy. Int J Radiat Oncol Biol Phys. 2008;70(April (5)):1397–1402. PubMed PMC

De Ruysscher D., Wanders S., van Haren E. Selective mediastinal node irradiation based on FDG-PET scan data in patients with non-small-cell lung cancer: a prospective clinical study. Int J Radiat Oncol Biol Phys. 2005. 2005;62(July (4)):988–994. PubMed

Senan S., De Ruysscher D., Giraud P. Radiotherapy Group of European Organization for Research and Treatment of Cancer, Literature-based recommendations for treatment planning and execution in high-dose radiotherapy for lung cancer. Radiother Oncol. 2004;71(2):139–146. PubMed

De Ruysscher D., Faivre-Finn C., Nestle U. European Organisation for Research and Treatment of Cancer recommendations for planning and delivery of high-dose, high-precision radiotherapy for lung cancer. J Clin Oncol. 2010;28(36):5301–5310. PubMed

Milano M.T., Constine L.S., Okunieff P. Normal tissue tolerance dose metrics for radiation therapy of major organs. Semin Radiat Oncol. 2007;17(April (2)):131–140. PubMed

Barendsen G.W. Dose fractionation, dose rate and iso-effect relationships for normal tissue responses. Int J Radiat Oncol Biol Phys. 1982;8(November (11)):1981–1997. PubMed

http://biogray.atlasweb.cz/.

Vanuytsel L.J., Vansteenkiste J.F., Stroobants S.G. The impact of (18)F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) lymph node staging on the radiation treatment volumes in patients with non-small cell lung cancer. Radiother Oncol. 2000;55(June (3)):317–324. PubMed

Faria S.L., Menard S., Devic S. Impact of FDG-PET/CT on radiotherapy volume delineation in non-small-cell lung cancer and correlation of imaging stage with pathologic findings. Int J Radiat Oncol Biol Phys. 2008;4:035–38. PubMed

Saunders M., Dische S., Barrett A., Harvey A., Griffiths G., Palmar M. Continuous, hyperfractionated, accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: mature data from the randomised multicentre trial. CHART Steering committee. Radiother Oncol. 1999;52:137–148. PubMed

Rengan R., Rosenzweig K.E., Venkatraman E. Improved local control with higher doses of radiation in large-volume stage III non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2004;60:741–747. PubMed

Willner J., Baier K., Caragiani E., Tschammler A., Flentje M. Dose, volume, and tumor control prediction in primary radiotherapy of non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2002;52:382–389. PubMed

Nestle U., Walter K., Schmidt S. 18F-deoxyglucose positron emission tomography (FDG-PET) for the planning of radiotherapy in lung cancer: high impact in patients with atelectasis. Int J Radiat Oncol Biol Phys. 1999;44(June (3)):593–597. PubMed

Perea B.C., Villegas A.C., Delgado Rodríguez J.M. Recommendations of the Spanish Societies of Radiation Oncology (SEOR) Nuclear Medicine & Molecular Imaging (SEMNiM), and Medical Physics (SEFM) on 18F-FDG PET-CT for radiotherapy treatment planning. Rep Pract Onco Radiother. 2012;(November–December):298–318. PubMed PMC

Brianzoni E., Rossi G., Ancidei S. Radiotherapy planning: PET/CT scanner performances in the definition of gross tumour volume and clinical target volume. Eur J Nucl Med Mol Imaging. 2005;32(12):1392–1399. PubMed

Bradley J., Thorstad W.L., Mutic S. Impact of FDG-PET on radiation therapy volume delineation in non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2004;59(1):78–86. PubMed

Giraud P., Grahek D., Montravers F. CT and (18)F-deoxyglucose (FDG) image fusion for optimization of conformal radiotherapy of lung cancers. Int J Radiat Oncol Biol Phys. 2001;49(April (5)):1249–1257. PubMed

Erdi Y.E., Rosenzweig K., Erdi A.K. Radiotherapy treatment planning for patients with non-small cell lung cancer using positron emission tomography (PET) Radiother Oncol. 2002;62(1):51–60. PubMed

Fox J.L., Rengan R., O’Meara W. Does registration of PET and planning CT images decrease interobserver and intraobserver variation in delineating tumor volumes for non-small-cell lung cancer? Int J Radiat Oncol Biol Phys. 2005;62(May (1)):70–75. PubMed

Deniaud-Alexandre E., Touboul E., Lerouge D. Impact of computed tomography and 18F-deoxyglucose coincidence detection emission tomography image fusion for optimization of conformal radiotherapy in non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2005;63(December (5)):1432–1441. PubMed

Mah K., Caldwell C.B., Ung Y.C. The impact of (18)FDG-PET on target and critical organs in CT-based treatment planning of patients with poorly defined non-small-cell lung carcinoma: a prospective study. Int J Radiat Oncol Biol Phys. 2002;52(February (2)):339–350. PubMed

Videtic G.M., Rice T.W., Murthy S. Utility of positron emission tomography compared with mediastinoscopy for delineating involved lymph nodes in stage III lung cancer: insights for radiotherapy planning from a surgical cohort. Int J Radiat Oncol Biol Phys. 2008;72(November (3)):702–706. PubMed

Paulino A.C., Johnstone P.A. FDG-PET in radiotherapy treatment planning: Pandora's box? Int J Radiat Oncol Biol Phys. 2004;59(May (1)):4–5. PubMed

Paulsen F., Scheiderbauer J., Eschmann S.M. First experiences of radiation treatment planning with PET/CT. Strahlenther Onkol. 2006;182(July (7)):369–375. PubMed

Ashamalla H., Rafla S., Parikh K. The contribution of integrated PET/CT to the evolving definition of treatment volumes in radiation treatment planning in lung cancer. Int J Radiat Oncol Biol Phys. 2005;63(November (4)):1016–1023. PubMed

Singh A.K., Lockett M.A., Bradley J.D. Predictors of radiation-induced esophageal toxicity in patients with non-small-cell lung cancer treated with three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2003;55(February (2)):337–341. PubMed

MacManus M., D’Costa I., Everitt S. Comparison of CT and positron emission tomography/CT coregistered images in planning radical radiotherapy in patients with non-small-cell lung cancer. Australas Radiol. 2007;51(August (4)):386–393. PubMed

Ceresoli G.L., Cattaneo G.M., Castellone P. Role of computed tomography and [18F] fluorodeoxyglucose positron emission tomography image fusion in conformal radiotherapy of non-small cell lung cancer: a comparison with standard techniques with and without elective nodal irradiation. Tumori. 2007;93(January–February (1)):88–96. PubMed

van Der Wel A., Nijsten S., Hochstenbag M. Increased therapeutic ratio by 18FDG-PET CT planning in patients with clinical CT stage N2-N3M0 non-small-cell lung cancer: a modeling study. Int J Radiat Oncol Biol Phys. 2005;61(March (3)):649–655. PubMed

Cardiac toxicity of lung cancer radiotherapy