PET-based dose painting in non-small cell lung cancer: Comparing uniform dose escalation with boosting hypoxic and metabolically active sub-volumes. Issue 2 (August 2015)

• Record Type: Journal Article
• Authors: Even, Aniek J.G.; van der Stoep, Judith; Zegers, Catharina M.L.; Reymen, Bart; Troost, Esther G.C.; Lambin, Philippe; van Elmpt, Wouter
• Is Part Of: Radiotherapy and oncology. Volume 116:Issue 2(2015:Aug.)
• Page Start: 281
• Page End: 286
• Publication Date: 2015-08
• Subjects: NSCLC -- Radiotherapy -- Dose painting -- Positron emission tomography -- FDG -- HX4; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2015.07.013
• Languages: English
• ISSNs: 0167-8140

Abstract

Abstract: Background and purpose: We compared two imaging biomarkers for dose-escalation in patients with advanced non-small cell lung cancer (NSCLC). Treatment plans boosting metabolically active sub-volumes defined by FDG-PET or hypoxic sub-volumes defined by HX4-PET were compared with boosting the entire tumour. Materials and methods: Ten NSCLC patients underwent FDG- and HX4-PET/CT scans prior to radiotherapy. Three isotoxic dose-escalation plans were compared per patient: plan A, boosting the primary tumour (PTVprim ); plan B, boosting sub-volume with FDG >50% SUVmax (PTVFDG ); plan C, boosting hypoxic volume with HX4 tumour-to-background >1.4 (PTVHX4 ). Results: Average boost volumes were 507 ± 466 cm 3 for PTVprim, 173 ± 127 cm 3 for PTVFDG and 114 ± 73 cm 3 for PTVHX4 . The smaller PTVHX4 overlapped on average 87 ± 16% with PTVFDG . Prescribed dose was escalated to 87 ± 10 Gy for PTVprim, 107 ± 20 Gy for PTVFDG, and 117 ± 15 Gy for PTVHX4, with comparable doses to the relevant organs-at-risk (OAR). Treatment plans are available online (https://www.cancerdata.org/10.1016/j.radonc.2015.07.013 ). Conclusions: Dose escalation based on metabolic sub-volumes, hypoxic sub-volumes and the entire tumour is feasible. Highest dose was achieved for hypoxia plans, without increasing dose to OAR. For most patients, boosting the metabolic sub-volume also resulted in boosting the hypoxic volume, although to a lower dose, but not vice versa .