Guido Alessandra, Fuccio Lorenzo, Rombi Barbara, Castellucci Paolo, Cecconi Agnese, Bunkheila Feisal, Fuccio Chiara, Spezi Emiliano, Angelini Anna Lisa, Barbieri Enza
Division of Radiation Oncology, Policlinico S Orsola, Bologna, Italy.
Int J Radiat Oncol Biol Phys. 2009 Mar 1;73(3):759-63. doi: 10.1016/j.ijrobp.2008.04.059. Epub 2008 Oct 1.
To evaluate the effect of the use of (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in radiotherapy target delineation for head-and-neck cancer compared with CT alone.
A total of 38 consecutive patients with head-and-neck cancer were included in this study. The primary tumor sites were as follow: 20 oropharyngeal tumors, 4 laryngeal tumors, 2 hypopharyngeal tumors, 2 paranasal sinuses tumors, 9 nasopharyngeal tumors, and 1 parotid gland tumor. The FDG-PET and CT scans were performed with a dedicated PET/CT scanner in one session and then fused. Subsequently, patients underwent treatment planning CT with intravenous contrast enhancement. The radiation oncologist defined all gross tumor volumes (GTVs) using both the PET/CT and CT scans.
In 35 (92%) of 38 cases, the CT-based GTVs were larger than the PET/CT-based GTVs. The average total GTV from the CT and PET/CT scans was 34.54 cm(3) (range, 3.56-109) and 29.38 cm(3) (range, 2.87-95.02), respectively (p < 0.05). Separate analyses of the difference between the CT- and PET/CT-based GTVs of the primary tumor compared with the GTVs of nodal disease were not statistically significant. The comparison between the PET/CT-based and CT-based boost planning target volumes did not show a statistically significant difference. All patients were alive at the end of the follow-up period (range, 3-38 months).
GTVs, but not planning target volumes, were significantly changed by the implementation of combined PET/CT. Large multicenter studies are needed to ascertain whether combined PET/CT in target delineation can influence the main clinical outcomes.
评估与单纯计算机断层扫描（CT）相比，(18)F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）在头颈部癌放疗靶区勾画中的应用效果。
本研究共纳入38例连续的头颈部癌患者。原发肿瘤部位如下：20例口咽肿瘤、4例喉肿瘤、2例下咽肿瘤、2例鼻窦肿瘤、9例鼻咽肿瘤和1例腮腺肿瘤。FDG-PET和CT扫描在一次检查中使用专用PET/CT扫描仪进行，然后融合。随后，患者接受静脉增强的治疗计划CT扫描。放射肿瘤学家使用PET/CT和CT扫描确定所有大体肿瘤体积（GTV）。
38例中的35例（92%），基于CT的GTV大于基于PET/CT的GTV。CT和PET/CT扫描的平均总GTV分别为34.54 cm³（范围3.56 - 109）和29.38 cm³（范围2.87 - 95.02）（p < 0.05）。将原发肿瘤基于CT和PET/CT的GTV与淋巴结疾病的GTV之间的差异进行单独分析，差异无统计学意义。基于PET/CT和基于CT的加量计划靶体积之间的比较未显示出统计学显著差异。所有患者在随访期结束时均存活（范围3 - 38个月）。
联合PET/CT的实施使GTV有显著变化，但计划靶体积没有。需要开展大型多中心研究以确定在靶区勾画中联合PET/CT是否会影响主要临床结局。
