Use of FDG-PET to guide dose prescription heterogeneity in stereotactic body radiation therapy for lung cancers with volumetric modulated arc therapy: a feasibility study

Radiation Oncology

Philippe Fernandez²  Mathieu Hatt⁴  Frédéric Lamare²  Adeline Petit¹  Philippe Lagarde¹  Renaud Trouette³  Mikael Antoine¹  Bénédicte Henriques de Figueiredo¹ 

[1] Department of Radiotherapy, Institut Bergonié, 229, cours de l’Argonne, Bordeaux Cedex, F-33076, France;Department of Nuclear Medicine, Hospital Pellegrin, CHRU Bordeaux, Bordeaux F-33076, France;Department of Radiotherapy, Hospital Haut-Lévêque, CHRU Bordeaux, Bordeaux F-33076, France;LaTIM INSERM, Brest, U1101, France

关键词: Volumetric modulated arc therapy;    Positron emission tomography;    Lung cancer;    Stereotactic body radiation therapy;   

Others  :  1150305
DOI  :  10.1186/s13014-014-0300-9

 received in 2014-09-30, accepted in 2014-12-14,  发布年份 2014

【 摘 要 】

Background

The aim of this study was to assess if FDG-PET could guide dose prescription heterogeneity and decrease arbitrary location of hotspots in SBRT.

Methods

For three patients with stage I lung cancer, a CT-simulation and a FDG-PET were registered to define respectively the PTV_CT and the biological target volume (BTV). Two plans involving volumetric modulated arc therapy (VMAT) and simultaneous integrated boost (SIB) were calculated. The first plan delivered 4 × 12 Gy within the PTV_CT and the second plan, with SIB, 4 × 12 Gy and 13.8 Gy (115% of the prescribed dose) within the PTV_CT and the BTV respectively. The Dmax-PTV_CT had to be inferior to 60 Gy (125% of the prescribed dose). Plans were evaluated through the D95%, D99% and Dmax-PTV_CT, the D2 cm, the R50% and R100% and the dice similarity coefficient (DSC) between the isodose 115% and BTV. DSC allows verifying the location of the 115% isodose (ideal value = 1).

Results

The mean PTV_CT and BTV were 36.7 (±12.5) and 6.5 (±2.2) cm³ respectively. Both plans led to similar target coverage, same doses to the OARs and equivalent fall-off of the dose outside the PTV_CT. On the other hand, the location of hotspots, evaluated through the DSC, was improved for the SIB plans with a mean DSC of 0.31 and 0.45 for the first and the second plans respectively.

Conclusions

Use of PET to decrease arbitrary location of hotspots is feasible with VMAT and SIB for lung cancer.

【 授权许可】

   
2014 Henriques de Figueiredo et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Baumann P, Nyman J, Hoyer M, Wennberg B, Gagliardi G, Lax I, Drugge N, Ekberg L, Friesland S, Johansson K-A, Lund J-A, Morhed E, Nilsson K, Levin N, Paludan M, Sederholm C, Traberg A, Wittgren L, Lewensohn R: Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy. J Clin Oncol Off J Am Soc Clin Oncol 2009, 27:3290-3296.
• [2]Brock J, Ashley S, Bedford J, Nioutsikou E, Partridge M, Brada M: Review of hypofractionated small volume radiotherapy for early-stage non-small cell lung cancer. Clin Oncol R Coll Radiol G B 2008, 20:666-676.
• [3]Fakiris AJ, McGarry RC, Yiannoutsos CT, Papiez L, Williams M, Henderson MA, Timmerman R: Stereotactic body radiation therapy for early-stage non-small-cell lung carcinoma: four-year results of a prospective phase II study. Int J Radiat Oncol Biol Phys 2009, 75:677-682.
• [4]Lagerwaard FJ, Haasbeek CJA, Smit EF, Slotman BJ, Senan S: Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2008, 70:685-692.
• [5]Hurkmans CW, Cuijpers JP, Lagerwaard FJ, Widder J, van der Heide UA, Schuring D, Senan S: Recommendations for implementing stereotactic radiotherapy in peripheral stage IA non-small cell lung cancer: report from the quality assurance working party of the randomised phase III ROSEL study. Radiat Oncol Lond Engl 2009, 4:1. BioMed Central Full Text
• [6]Verbakel WFAR, Senan S, Cuijpers JP, Slotman BJ, Lagerwaard FJ: Rapid delivery of stereotactic radiotherapy for peripheral lung tumors using volumetric intensity-modulated arcs. Radiother Oncol J Eur Soc Ther Radiol Oncol 2009, 93:122-124.
• [7]Abramyuk A, Tokalov S, Zöphel K, Koch A, Szluha Lazanyi K, Gillham C, Herrmann T, Abolmaali N: Is pre-therapeutical FDG-PET/CT capable to detect high risk tumor subvolumes responsible for local failure in non-small cell lung cancer? Radiother Oncol J Eur Soc Ther Radiol Oncol 2009, 91:399-404.
• [8]Aerts HJWL, van Baardwijk AAW, Petit SF, Offermann C, van Loon J, Houben R, Dingemans A-MC, Wanders R, Boersma L, Borger J, Bootsma G, Geraedts W, Pitz C, Simons J, Wouters BG, Oellers M, Lambin P, Bosmans G, Dekker ALAJ, De Ruysscher D: Identification of residual metabolic-active areas within individual NSCLC tumours using a pre-radiotherapy (18)Fluorodeoxyglucose-PET-CT scan. Radiother Oncol J Eur Soc Ther Radiol Oncol 2009, 91:386-392.
• [9]Hatt M, Cheze le Rest C, Turzo A, Roux C, Visvikis D: A fuzzy locally adaptive Bayesian segmentation approach for volume determination in PET. IEEE Trans Med Imaging 2009, 28:881-893.
• [10]Wanet M, Lee JA, Weynand B, De Bast M, Poncelet A, Lacroix V, Coche E, Grégoire V, Geets X: Gradient-based delineation of the primary GTV on FDG-PET in non-small cell lung cancer: a comparison with threshold-based approaches, CT and surgical specimens. Radiother Oncol J Eur Soc Ther Radiol Oncol 2011, 98:117-125.
• [11]Ong CL, Verbakel WFAR, Cuijpers JP, Slotman BJ, Lagerwaard FJ, Senan S: Stereotactic radiotherapy for peripheral lung tumors: a comparison of volumetric modulated arc therapy with 3 other delivery techniques. Radiother Oncol J Eur Soc Ther Radiol Oncol 2010, 97:437-442.
• [12]Zhang GG, Ku L, Dilling TJ, Stevens CW, Zhang RR, Li W, Feygelman V: Volumetric modulated arc planning for lung stereotactic body radiotherapy using conventional and unflattened photon beams: a dosimetric comparison with 3D technique. Radiat Oncol Lond Engl 2011, 6:152. BioMed Central Full Text
• [13]Holt A, van Vliet-Vroegindeweij C, Mans A, Belderbos JS, Damen EMF: Volumetric-modulated arc therapy for stereotactic body radiotherapy of lung tumors: a comparison with intensity-modulated radiotherapy techniques. Int J Radiat Oncol Biol Phys 2011, 81:1560-1567.
• [14]McGrath SD, Matuszak MM, Yan D, Kestin LL, Martinez AA, Grills IS: Volumetric modulated arc therapy for delivery of hypofractionated stereotactic lung radiotherapy: A dosimetric and treatment efficiency analysis. Radiother Oncol J Eur Soc Ther Radiol Oncol 2010, 95:153-157.
• [15]Navarria P, Ascolese AM, Mancosu P, Alongi F, Clerici E, Tozzi A, Iftode C, Reggiori G, Tomatis S, Infante M, Alloisio M, Testori A, Fogliata A, Cozzi L, Morenghi E, Scorsetti M: Volumetric modulated arc therapy with flattening filter free (FFF) beams for stereotactic body radiation therapy (SBRT) in patients with medically inoperable early stage non small cell lung cancer (NSCLC). Radiother Oncol J Eur Soc Ther Radiol Oncol 2013, 107:414-418.
• [16]Bortfeld T, Jiang SB, Rietzel E: Effects of motion on the total dose distribution. Semin Radiat Oncol 2004, 14:41-51.
• [17]Ong C, Verbakel WFAR, Cuijpers JP, Slotman BJ, Senan S: Dosimetric impact of interplay effect on RapidArc lung stereotactic treatment delivery. Int J Radiat Oncol Biol Phys 2011, 79:305-311.
• [18]Rao M, Wu J, Cao D, Wong T, Mehta V, Shepard D, Ye J: Dosimetric impact of breathing motion in lung stereotactic body radiotherapy treatment using intensity modulated radiotherapy and volumetric modulated arc therapy [corrected]. Int J Radiat Oncol Biol Phys 2012, 83:e251-e256.
• [19]Videtic GMM, Stephans K, Reddy C, Gajdos S, Kolar M, Clouser E, Djemil T: Intensity-modulated radiotherapy-based stereotactic body radiotherapy for medically inoperable early-stage lung cancer: excellent local control. Int J Radiat Oncol Biol Phys 2010, 77:344-349.
• [20]Yamashita H, Takahashi W, Haga A, Kida S, Saotome N, Nakagawa K: Stereotactic body radiotherapy for small lung tumors in the university of Tokyo hospital. BioMed Res Int 2014, 2014:136513.