Department of Radiation Oncology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Japan.
J Radiat Res. 2013 Jul 1;54(4):671-8. doi: 10.1093/jrr/rrs131. Epub 2013 Jan 3.
We analyzed the data for 53 patients with histologically proven primary squamous cell carcinoma of the head and neck treated with radiotherapy between February 2006 and August 2009. All patients underwent contrast-enhanced (CE)-CT and (18)F-fluorodeoxyglucose (FDG)-PET before radiation therapy planning (RTP) to define the gross tumor volume (GTV). The PET-based GTV (PET-GTV) for RTP was defined using both CE-CT images and FDG-PET images. The CE-CT tumor volume corresponding to a FDG-PET image was regarded as the PET-GTV. The CE-CT-based GTV (CT-GTV) for RTP was defined using CE-CT images alone. Additionally, CT-GTV delineation and PET-GTV delineation were performed by four radiation oncologists independently in 19 cases. All four oncologists did both methods. Of these, PET-GTV delineation was successfully performed in all 19 cases, but CT-GTV delineation was not performed in 4 cases. In the other 15 cases, the mean CT-GTV was larger than the PET-GTV in 10 cases, and the standard deviation of the CT-GTV was larger than that of the PET-GTV in 10 cases. Sensitivity of PET-GTV for identifying the primary tumor was 96%, but that of CT-GTV was 81% (P < 0.01). In patients with oropharyngeal cancer and tongue cancer, the sensitivity of CT-GTV was 63% and 71%, respectively. When both the primary lesions and the lymph nodes were evaluated for RTP, PET-GTV differed from CT-GTV in 19 cases (36%). These results suggested that FDG-PET is effective for defining GTV in RTP for squamous cell carcinoma of the head and neck, and PET-GTV evaluated by both CE-CT and FDG-PET images is preferable to CT-GTV by CE-CT alone.
我们分析了 53 例经组织学证实的头颈部鳞状细胞癌患者的数据，这些患者均于 2006 年 2 月至 2009 年 8 月接受放射治疗。所有患者在放射治疗计划（RTP）前均进行了对比增强（CE）-CT 和（18）F-氟脱氧葡萄糖（FDG）-PET 检查，以确定大体肿瘤体积（GTV）。RTP 的基于 PET 的 GTV（PET-GTV）使用 CE-CT 图像和 FDG-PET 图像定义。与 FDG-PET 图像对应的 CE-CT 肿瘤体积被视为 PET-GTV。RTP 的基于 CE-CT 的 GTV（CT-GTV）仅使用 CE-CT 图像定义。此外，在 19 例患者中，由 4 名放射肿瘤学家独立进行 CT-GTV 勾画和 PET-GTV 勾画。这 4 位肿瘤学家均进行了两种方法。其中，19 例患者均成功进行了 PET-GTV 勾画，但有 4 例患者未进行 CT-GTV 勾画。在另外 15 例患者中，10 例 CT-GTV 大于 PET-GTV，10 例 CT-GTV 的标准差大于 PET-GTV。PET-GTV 识别原发肿瘤的敏感性为 96%，而 CT-GTV 的敏感性为 81%（P<0.01）。在口咽癌和舌癌患者中，CT-GTV 的敏感性分别为 63%和 71%。当评估原发灶和淋巴结的 RTP 时，PET-GTV 与 CT-GTV 在 19 例患者中（36%）存在差异。这些结果表明，FDG-PET 对头颈部鳞状细胞癌 RTP 中 GTV 的定义是有效的，并且通过 CE-CT 和 FDG-PET 图像评估的 PET-GTV 优于单独通过 CE-CT 的 CT-GTV。
