Wang Dian, Schultz Christopher J, Jursinic Paul A, Bialkowski Mirek, Zhu X Ronald, Brown W Douglas, Rand Scott D, Michel Michelle A, Campbell Bruce H, Wong Stuart, Li X Allen, Wilson J Frank
Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53045, USA.
Int J Radiat Oncol Biol Phys. 2006 May 1;65(1):143-51. doi: 10.1016/j.ijrobp.2005.11.048.
The purpose of this study is to evaluate the impact of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) fused with planning computed tomography (CT) on tumor localization, which guided intensity-modulated radiotherapy (IMRT) of patients with head-and-neck carcinoma.
From October 2002 through April 2005, we performed FDG-PET/CT guided IMRT for 28 patients with head-and-neck carcinoma. Patients were immobilized with face masks that were attached with five fiducial markers. FDG-PET and planning CT scans were performed on the same flattop table in one session and were then fused. Target volumes and critical organs were contoured, and IMRT plans were generated based on the fused images.
All 28 patients had abnormal increased uptake in FDG-PET/CT scans. PET/CT resulted in CT-based staging changes in 16 of 28 (57%) patients. PET/CT fusions were successfully performed and were found to be accurate with the use of the two commercial planning systems. Volume analysis revealed that the PET/CT-based gross target volumes (GTVs) were significantly different from those contoured from the CT scans alone in 14 of 16 patients. In addition, 16 of 28 patients who were followed for more than 6 months did not have any evidence of locoregional recurrence in the median time of 17 months.
Fused images were found to be useful to delineate GTV required in IMRT planning. PET/CT should be considered for both initial staging and treatment planning in patients with head-and-neck carcinoma.
本研究旨在评估18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）与计划计算机断层扫描（CT）融合对肿瘤定位的影响，该融合技术可指导头颈部癌患者的调强放射治疗（IMRT）。
2002年10月至2005年4月，我们对28名头颈部癌患者进行了FDG-PET/CT引导下的IMRT。患者使用附着有五个基准标记的面罩进行固定。FDG-PET和计划CT扫描在同一平板床上一次完成，然后进行融合。勾勒出靶区体积和关键器官，并根据融合图像生成IMRT计划。
所有28例患者的FDG-PET/CT扫描均显示摄取异常增加。PET/CT使28例患者中的16例（57%）基于CT的分期发生了改变。成功进行了PET/CT融合，并且发现在使用两种商业计划系统时是准确的。体积分析显示，16例患者中有14例基于PET/CT的大体肿瘤体积（GTV）与仅根据CT扫描勾勒出的体积有显著差异。此外，28例随访超过6个月的患者中，有16例在中位时间17个月时没有任何局部区域复发的证据。
发现融合图像有助于勾勒IMRT计划所需的GTV。对于头颈部癌患者的初始分期和治疗计划，均应考虑使用PET/CT。
