PMID- 18394814
OWN - NLM
STAT- MEDLINE
DCOM- 20080624
LR  - 20191210
IS  - 0360-3016 (Print)
IS  - 0360-3016 (Linking)
VI  - 71
IP  - 2
DP  - 2008 Jun 1
TI  - Comparison of FDG-PET/CT and CT for delineation of lumpectomy cavity for partial 
      breast irradiation.
PG  - 595-602
LID - 10.1016/j.ijrobp.2008.02.004 [doi]
AB  - PURPOSE: The success of partial breast irradiation critically depends on proper 
      target localization. We examined the use of fluorodeoxyglucose-positron emission 
      tomography (FDG-PET)/computed tomography (CT) for improved lumpectomy cavity (LC) 
      delineation and treatment planning. METHODS AND MATERIALS: Twelve breast cancer 
      patients underwent FDG-PET/CT on a GE Discovery scanner with a median time from 
      surgery to PET/CT of 49 days. The LC was contoured on the CT scan by a radiation 
      oncologist and, together with a nuclear medicine physician, on the PET/CT scan. 
      The volumes were calculated and compared in each patient. Treatment planning 
      target volumes (PTVs) were calculated by expanding the margin 2 cm beyond the LC, 
      maintaining a 5-mm margin from the skin and chest wall, and the treatment plans 
      were evaluated. In addition, a study with a patient-like phantom was conducted to 
      evaluate the effect that the window/level settings might have on contouring. 
      RESULTS: The margin of the LC was well visualized on all FDG-PET images. The 
      phantom results indicated that the difference between the known volume and the 
      FDG-PET-delineated volume was <10%, regardless of the window/level settings. The 
      PET/CT volumes were larger than the CT volumes in all cases (median volume ratio, 
      1.68; range, 1.24-2.45; p = 0.004). The PET/CT-based PTVs were also larger than 
      the CT-based PTV (median volume ratio, 1.16; range, 1.08-1.64; p = 0.006). In 9 
      of 12 patients, a CT-based treatment plan did not provide adequate coverage of 
      the PET/CT-based PTV (99% of the PTV received <95% of the prescribed dose), 
      resulting in substantial cold spots in some plans. In these cases, treatment 
      plans were generated which were specifically designed to cover the larger 
      PET/CT-based PTV. Although these plans showed an increased dose to the normal 
      tissues, the increases were modest: the non-target breast volume receiving > or 
      =50 Gy, lung volume receiving > or =30 Gy, and heart volume receiving > or =5 Gy 
      increased by 5.7%, 0.8%, and 0.2%, respectively. The normal tissue dose-volume 
      objectives were still met with these plans. CONCLUSION: The results of our study 
      have shown that FDG-PET/CT can be used to define the LC volume. The increased FDG 
      uptake was likely a result of postoperative inflammation in the LC. The targets 
      defined using PET/CT were significantly larger than those defined with CT alone. 
      Our results have shown that treatment plans can be generated to cover these 
      larger PET/CT target volumes with only a modest increase in irradiated tissue 
      volume compared with CT-determined PTVs.
FAU - Ford, Eric C
AU  - Ford EC
AD  - Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins 
      University, Baltimore, MD 21231, USA. eric.ford@jhmi.edu.
FAU - Lavely, William C
AU  - Lavely WC
FAU - Frassica, Deborah A
AU  - Frassica DA
FAU - Myers, Lee T
AU  - Myers LT
FAU - Asrari, Fariba
AU  - Asrari F
FAU - Wahl, Richard L
AU  - Wahl RL
FAU - Zellars, Richard C
AU  - Zellars RC
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20080418
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
RN  - 0 (Radiopharmaceuticals)
RN  - 0Z5B2CJX4D (Fluorodeoxyglucose F18)
SB  - IM
MH  - Breast/diagnostic imaging/surgery
MH  - Breast Neoplasms/*diagnostic imaging/radiotherapy/surgery
MH  - Female
MH  - Fluorodeoxyglucose F18
MH  - Humans
MH  - Mammography/methods
MH  - *Mastectomy, Segmental
MH  - Positron-Emission Tomography/*methods
MH  - Radiopharmaceuticals
MH  - Tomography, X-Ray Computed/*methods
MH  - Tumor Burden
EDAT- 2008/04/09 09:00
MHDA- 2008/06/25 09:00
CRDT- 2008/04/09 09:00
PHST- 2007/08/06 00:00 [received]
PHST- 2008/02/05 00:00 [revised]
PHST- 2008/02/05 00:00 [accepted]
PHST- 2008/04/09 09:00 [pubmed]
PHST- 2008/06/25 09:00 [medline]
PHST- 2008/04/09 09:00 [entrez]
AID - S0360-3016(08)00277-0 [pii]
AID - 10.1016/j.ijrobp.2008.02.004 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2008 Jun 1;71(2):595-602. doi: 
      10.1016/j.ijrobp.2008.02.004. Epub 2008 Apr 18.