Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France.
Department of Biostatistics and Epidemiology, Institut Gustave Roussy, Villejuif, France.
Int J Radiat Oncol Biol Phys. 2014 Aug 1;89(5):1047-1052. doi: 10.1016/j.ijrobp.2014.04.026. Epub 2014 Jul 8.
This study examines the role of (18)F-labeled fluorodeoxyglucose positron emission tomography (FDG-PET) in the implementation of involved-node radiation therapy (INRT) in patients treated for clinical stages (CS) I/II supradiaphragmatic Hodgkin lymphoma (HL).
Patients with untreated CS I/II HL enrolled in the randomized EORTC/LYSA/FIL Intergroup H10 trial and participating in a real-time prospective quality assurance program were prospectively included in this study. Data were electronically obtained from 18 French cancer centers. All patients underwent APET-computed tomography (PET-CT) and a post-chemotherapy planning CT scanning. The pre-chemotherapy gross tumor volume (GTV) and the postchemotherapy clinical target volume (CTV) were first delineated on CT only by the radiation oncologist. The planning PET was then co-registered, and the delineated volumes were jointly analyzed by the radiation oncologist and the nuclear medicine physician. Lymph nodes undetected on CT but FDG-avid were recorded, and the previously determined GTV and CTV were modified according to FDG-PET results.
From March 2007 to February 2010, 135 patients were included in the study. PET-CT identified at least 1 additional FDG-avid lymph node in 95 of 135 patients (70.4%; 95% confidence interval [CI]: 61.9%-77.9%) and 1 additional lymph node area in 55 of 135 patients (40.7%; 95% CI: 32.4%-49.5%). The mean increases in the GTV and CTV were 8.8% and 7.1%, respectively. The systematic addition of PET to CT led to a CTV increase in 60% of the patients.
Pre-chemotherapy FDG-PET leads to significantly better INRT delineation without necessarily increasing radiation volumes.
本研究探讨了正电子发射断层扫描（PET）在接受临床 I/II 期膈上霍奇金淋巴瘤（HL）治疗的患者中实施受累淋巴结放疗（INRT）中的作用。
这项前瞻性研究纳入了来自 18 个法国癌症中心的患者数据，这些患者均为未接受治疗的临床 I/II 期膈上 HL，参加了 EORTC/LYSA/FIL 国际组 H10 随机试验，并参与了实时前瞻性质量保证计划。所有患者均接受了前位 PET-计算机断层扫描（PET-CT）和化疗后计划 CT 扫描。首先由放射肿瘤学家在 CT 上单独勾画化疗前的大体肿瘤体积（GTV）和化疗后临床靶区（CTV）。然后，将计划 PET 与 CT 进行配准，并由放射肿瘤学家和核医学医师共同分析勾画的体积。记录了 CT 上未检测到但 FDG 摄取的淋巴结，并根据 FDG-PET 结果修改了先前确定的 GTV 和 CTV。
2007 年 3 月至 2010 年 2 月，共纳入了 135 例患者。在 135 例患者中，PET-CT 在 95 例（70.4%；95%置信区间[CI]：61.9%-77.9%）患者中至少发现了 1 个额外的 FDG 摄取淋巴结，在 55 例（40.7%；95% CI：32.4%-49.5%）患者中发现了 1 个额外的淋巴结区域。GTV 和 CTV 的平均增加分别为 8.8%和 7.1%。PET 与 CT 系统相加导致 60%的患者 CTV 增加。
在不增加照射体积的情况下，化疗前 FDG-PET 可显著改善 INRT 勾画。
