Impact of FDG-PET/CT on Radiotherapy Volume Delineation in Non–Small-Cell Lung Cancer and Correlation of Imaging Stage With Pathologic Findings

• Published in: International journal of radiation oncology, biology, physics Vol. 70; no. 4; pp. 1035 - 1038
• Main Authors: Faria, Sergio L., M.D., Ph.D, Menard, Sonia, Devic, Slobodan, Ph.D, Sirois, Christian, M.D, Souhami, Luis, M.D, Lisbona, Robert, M.D, Freeman, Carolyn R., M.B.B.S., F.R.C.P.C
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.03.2008
• Subjects: ALGORITHMS; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - pathology; CARCINOMAS; COMPUTERIZED TOMOGRAPHY; CORRELATIONS; FLUORODEOXYGLUCOSE; Guidelines as Topic; Hematology, Oncology and Palliative Medicine; Humans; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; LUNGS; Mediastinal Neoplasms - diagnostic imaging; Mediastinal Neoplasms - pathology; MEDIASTINUM; Neoplasm Staging - methods; Non–small-cell lung cancer; NSCLC; PATIENTS; PET; POSITRON COMPUTED TOMOGRAPHY; Positron emission tomography; Positron-Emission Tomography - methods; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed - methods; Non–small-cell lung cancer; NSCLC; Radiotherapy; Positron emission tomography; PET
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2007.07.2379

Purpose Fluorodeoxyglucose-positron emission tomography (FDG-PET)/computed tomography (CT) is more accurate than CT in determining the extent of non–small-cell lung cancer. We performed a study to evaluate the impact of FDG-PET/CT on the radiotherapy volume delineation compared with CT without using any mathematical algorithm and to correlate the findings with the pathologic examination findings. Methods and Materials A total of 32 patients with proven non–small-cell lung cancer, pathologic specimens from the mediastinum and lung primary, and pretreatment chest CT and FDG-PET/CT scans were studied. For each patient, two data sets of theoretical gross tumor volumes were contoured. One set was determined using the chest CT only, and the second, done separately, was based on the co-registered FDG-PET/CT data. The disease stage of each patient was determined using the TNM staging system for three data sets: the CT scan only, FDG-PET/CT scan, and pathologic findings. Results Pathologic examination altered the CT-determined stage in 22 (69%) of 32 patients and the PET-determined stage in 16 (50%) of 32 patients. The most significant alterations were related to the N stage. PET altered the TNM stage in 15 (44%) of 32 patients compared with CT alone, but only 7 of these 15 alterations were confirmed by the pathologic findings. With respect to contouring the tumor volume for radiotherapy, PET altered the contour in 18 (56%) of 32 cases compared with CT alone. Conclusion The contour of the tumor volume of non–small-cell lung cancer patients with co-registered FDG-PET/CT resulted in >50% alterations compared with CT targeting, findings similar to those of other publications. However, the significance of this change is unknown. Furthermore, pathologic examination showed that PET is not always accurate and histologic examination should be obtained to confirm the findings of PET whenever possible.