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Comparison Of CT And Integrated PET-CT Based Radiation Therapy Planning In Patients With Malignant Pleural Mesothelioma

B. Pehlivan, E. Topkan, C. Onal, Gul Nihal Nursal, O. Yuksel, Y. Dolek, M. Yavuz, A. Yavuz
Published 2009 · Medicine

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BackgroundWhen combined with adequate tumoricidal doses, accurate target volume delineation remains to be the one of the most important predictive factors for radiotherapy (RT) success in locally advanced or medically inoperable malignant pleural mesothelioma (MPM) patients. Recently, 18-fluorodeoxyglucose positron emission tomography (PET) has demonstrated significant improvements in diagnosis and accurate staging of MPM. However, role of additional PET data has not been studied in RT planning (RTP) of patients with inoperable MPM or in those who refuse surgery. Therefore, we planned to compare CT with co-registered PET-CT as the basis for delineating target volumes in these patients group.MethodsRetrospectively, the CT and co-registered PET-CT data of 13 patients with histologically proven MPM were utilized to delineate target volumes separately. For each patient, target volumes (gross tumor volume [GTV], clinical target volume [CTV], and planning target volume [PTV]) were defined using the CT and PET-CT fusion data sets. The PTV was measured in two ways: PTV1 was CTV plus a 1-cm margin, and PTV2 was GTV plus a 1-cm margin. We analyzed differences in target volumes.ResultsIn 12 of 13 patients, compared to CT-based delineation, PET-CT-based delineation resulted in a statistically significant decrease in the mean GTV, CTV, PTV1, and PTV2. In these 12 patients, mean GTV decreased by 47.1% ± 28.4%, mean CTV decreased by 38.7% ± 24.7%, mean PTV1 decreased by 31.1% ± 23.1%, and mean PTV2 decreased by 40.0% ± 24.0%. In 4 of 13 patients, hilar lymph nodes were identified by PET-CT that was not identified by CT alone, changing the nodal status of tumor staging in those patients.ConclusionThis study demonstrated the usefulness of PET-CT-based target volume delineation in patients with MPM. Co-registration of PET and CT information reduces the likelihood of geographic misses, and additionally, significant reductions observed in target volumes may potentially allow escalation of RT dose beyond conventional limits potential clinical benefits in tumor control rates, which needs to be tested in future studies.
This paper references
10.1007/s11604-008-0281-4
Helical tomotherapy for total lymphoid irradiation
Kathryn W. McCutchen (2008)
10.1158/0008-5472.CAN-05-4642
Genetic predisposition to fiber carcinogenesis causes a mesothelioma epidemic in Turkey.
A. Dogan (2006)
The current status of PET-FDG in tumor voulme definition in radiotherapy treatment planning
A van Baardwick (2006)
10.1016/S1095-0397(01)00055-3
Combined PET/CT Imaging in Oncology. Impact on Patient Management.
P. G. Kluetz (2000)
10.3816/CLC.2004.N.008
Integration of multimodality approaches in the management of malignant pleural mesothelioma.
Derlis Martino (2004)
10.1097/00000421-199002000-00002
The Treatment of Malignant Mesothelioma of the Pleura: Review of a 5‐Year Experience, With Special Reference to Radiotherapy
D. Ball (1990)
Geneticsuspectibility factor and malignant mesothelioma in the Cappodocian region of Turkey
I Roushdy-Hammady (2001)
parison of CT and PET - CT based planning of radiation therapy in locally advanced pancreatic carcinoma
E Topkan (2008)
The role of computed tomography scanning in the initial assesment and the follow-up of malignant pleural mesothelioma
VW Rusch (1988)
Current status of PET/CT for tumor volume definition in radiotherapy planning for non-small cell lung cancer
G Carlo (2007)
Jenrette JM 3rd: Helical tomotherapy for total lymphoid irradiation
K W Mccutchen (2008)
10.1200/JCO.2008.20.3943
Multicenter phase II trial of neoadjuvant pemetrexed plus cisplatin followed by extrapleural pneumonectomy and radiation for malignant pleural mesothelioma.
L. Krug (2009)
10.1183/09031936.96.09122565
Effect of hemithorax irradiation alone or combined with doxorubicin and cyclophosphamide in 47 pleural mesotheliomas: a nonrandomized phase II study.
C. J. Lindén (1996)
10.1016/S1010-7940(00)00377-8
18-FDG positron emission tomography in the evaluation of malignant pleural diseases - a pilot study.
A. Carretta (2000)
10.1186/1756-9966-27-41
Comparison of CT and PET-CT based planning of radiation therapy in locally advanced pancreatic carcinoma
E. Topkan (2008)
10.1186/1477-7819-2-11
Multimodal treatment for resectable epithelial type malignant pleural mesothelioma
I. Yoshino (2004)
Computed tomography, positron emission tomograpy, positron emission tomograpy/computed tomography, and magnetic resonance imaging for staging of limited pleural meothelioma
C Plathow (2008)
10.1097/RLI.0b013e3181817b3d
Computed Tomography, Positron Emission Tomography, Positron Emission Tomography/Computed Tomography, and Magnetic Resonance Imaging for Staging of Limited Pleural Mesothelioma: Initial Results
C. Plathow (2008)
10.1016/J.CTRV.2006.02.002
The current status of FDG-PET in tumour volume definition in radiotherapy treatment planning.
A. V. van Baardwijk (2006)
Int J Radiat Oncol Biol Phys Int J Radiat Oncol Biol Phys
R Mohan (2008)
10.1016/S0022-5223(19)35312-7
The role of computed tomography scanning in the initial assessment and the follow-up of malignant pleural mesothelioma.
V. Rusch (1988)
18-FDG PET in the evaluation of malignant pleural disease: a pilot study
A Caretta (2000)
10.1016/S0720-048X(01)00426-0
Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases.
M. Metintas (2002)
10.2214/AJR.172.4.10587144
Staging of malignant pleural mesothelioma: comparison of CT and MR imaging.
R. Heelan (1999)
10.1016/J.LUNGCAN.2007.03.020
Current status of PET/CT for tumour volume definition in radiotherapy treatment planning for non-small cell lung cancer (NSCLC).
C. Greco (2007)
10.1016/J.THORSURG.2004.06.006
Patterns of failure following surgical resection for malignant pleural mesothelioma.
P. Jänne (2004)
10.1016/J.IJROBP.2003.10.044
Impact of FDG-PET on radiation therapy volume delineation in non-small-cell lung cancer.
J. Bradley (2004)
10.1378/CHEST.114.3.713
Metabolic imaging of malignant pleural mesothelioma with fluorodeoxyglucose positron emission tomography.
F. Bénard (1998)
10.1200/JCO.1989.7.8.1157
Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients.
P. Ruffié (1989)
10.1016/S0022-5223(99)70469-1
Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients.
D. Sugarbaker (1999)
10.1016/j.meddos.2007.11.001
Comparison of IMRT treatment plans between linac and helical tomotherapy based on integral dose and inhomogeneity index.
C. Shi (2008)
Current status of PET/CT for tumor volume definition in radiotherapy planning for non-small cell lung cancer (NSCLC)
G Carlo (2007)
10.1378/CHEST.108.4.1122
A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group.
V. Rusch (1995)
( NSCLC )
J Bradley (2007)
; 72 : 575 - 581 )
KW McCutchen
10.1016/S0022-5223(19)36577-8
The role of extrapleural pneumonectomy in malignant pleural mesothelioma. A Lung Cancer Study Group trial.
V. Rusch (1991)
10.1016/j.ijrobp.2009.03.021
Dueling Technologies: in regard to Ling et al. (Int J Radiat Oncol Biol Phys 2008;72:575-581).
R. Mohan (2009)
10.1016/J.JTCVS.2004.02.021
Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies.
D. Sugarbaker (2004)
Int J Radiat Oncol Biol Phys Int J Radiat Oncol Biol Phys
R Mohan (2008)
10.1016/S0360-3016(03)00346-8
Radiation treatment planning with an integrated positron emission and computer tomography (PET/CT): a feasibility study.
I. Ciernik (2003)
Multimodel treatment for resectable epithelial type malignant pleural mesothelioma
I Yoshino (2004)
10.1016/S0140-6736(00)04013-7
Genetic-susceptibility factor and malignant mesothelioma in the Cappadocian region of Turkey
Iman Roushdy-Hammady (2001)
10.1097/00000658-199609000-00005
Extrapleural pneumonectomy in the multimodality therapy of malignant pleural mesothelioma. Results in 120 consecutive patients.
D. Sugarbaker (1996)
10.1016/S1556-0864(15)31583-5
Induction Chemotherapy, Extrapleural Pneumonectomy, and Postoperative High-Dose Radiotherapy for Locally Advanced Malignant Pleural Mesothelioma: A Phase II Trial
R. Flores (2006)
Metabolic imaging of malignant mesothelioma with fluorodeoxradiation for malignant pleural mesothelioma
F Bénard (2009)
10.1016/S0360-3016(00)80050-4
Radiotherapy treatment planning for patients with non-small cell lung cancer using positron emission tomography (PET).
Y. Erdi (2002)
10.1200/JCO.2008.17.5604
Trimodality therapy with induction chemotherapy followed by extrapleural pneumonectomy and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma.
M. D. de Perrot (2009)
10.1016/S0360-3016(01)01824-7
The impact of (18)FDG-PET on target and critical organs in CT-based treatment planning of patients with poorly defined non-small-cell lung carcinoma: a prospective study.
K. Mah (2002)
10.1148/RADIOLOGY.178.3.1847239
CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group.
W. Webb (1991)
Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management.
R. Bar-Shalom (2003)
10.1097/01.rlu.0000167514.11891.f5
Incremental Value of Fusion Imaging With Integrated PET-CT in Oncology
C. Roman (2005)
10.1016/j.radonc.2007.12.010
Evaluating target coverage and normal tissue sparing in the adjuvant radiotherapy of malignant pleural mesothelioma: helical tomotherapy compared with step-and-shoot IMRT.
F. Sterzing (2008)
10.1067/MTC.2001.116560
A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma.
V. Rusch (2001)



This paper is referenced by
10.1111/j.1754-9485.2011.02274.x
Establishing locoregional control of malignant pleural mesothelioma using high‐dose radiotherapy and 18F‐FDG PET/CT scan correlation
M. Feigen (2011)
10.2482/HAIGAN.50.860
Imaging Evaluation of Diffuse Pleural Mesothelioma
Fumikazu Sakai (2010)
10.17265/2328-2150/2016.11.006
Value of FDG PET/CT in the Management of Mesothelioma
Mohamad Faizul Abu Hanifa (2016)
10.2214/AJR.13.10572
FDG PET/CT in the management of primary pleural tumors and pleural metastases.
Matthew J. Kruse (2013)
10.1007/978-3-319-26236-9
Nuclear Oncology
H. William Strauss (2017)
10.1016/J.REMNGL.2010.08.003
[Usefulness of 18F-FDG PET-CT in the presurgical assessment of malignant pleural mesothelioma treated with neoadjuvant chemotherapy].
Javier Orcajo Rincón (2011)
10.1007/978-3-319-26236-9_13
Diagnostic Applications of Nuclear Medicine: Lung and Mediastinal Tumors
Elite Arnon (2017)
10.2217/LMT.15.15
Optimizing hemithoracic pleural intensity-modulated radiation therapy for malignant pleural mesothelioma
F. Shaikh (2015)
Positronemissionstomografi/Datortomografi (PET/CT) inför dosplanering vid strålbehandling
Elin Vestman (2013)
10.1007/978-3-319-28761-4_19
Target Volume Delineation Guidelines in Malignant Pleural Mesothelioma
G. Ozyigit (2016)
10.1016/J.REMN.2010.08.008
Utilidad de la PET-TAC 18F-FDG en la valoración prequirúrgica del mesotelioma pleural maligno tras quimioterapia neoadyuvante
Javier Orcajo Rincón (2011)
10.1097/MNM.0000000000000246
18F-FDG PET/CT in hepatocellular carcinoma: detection of bone metastasis and prediction of prognosis
H. J. Seo (2015)
10.1007/978-0-387-48894-3_13
Lung and Mediastinal Tumors
S. Ben-Haim (2013)
10.3978/j.issn.2225-319X.2012.10.07
Novel radiation therapy approaches in malignant pleural mesothelioma.
A. Rimner (2012)
10.1007/978-3-319-52619-5_36-1
Radiation Therapy in Mesothelioma
J. Willmann (2019)
10.1155/2019/4568958
Dosimetric Comparison of Lung-Sparing Radiation Therapy between Volumetric Arc Therapy and Helical Tomotherapy for Unresectable Malignant Pleural Mesothelioma
B. Pehlivan (2019)
10.1007/s11307-010-0426-6
Current Evidence Base of FDG-PET/CT Imaging in the Clinical Management of Malignant Pleural Mesothelioma: Emerging Significance of Image Segmentation and Global Disease Assessment
S. Basu (2010)
10.1016/j.radonc.2017.08.003
The role of radical radiotherapy in the management of malignant pleural mesothelioma: A systematic review.
M. Ashton (2017)
10.1007/978-3-642-40582-2_7
Functional Imaging of Malignant Pleural Mesothelioma and other Pleural and Chest Wall Lesions
J. Broncano (2014)
10.17795/RRO-3999
F-18 FDG PET-CT Influences Target Delineation When Combined With Standard CT-Based Radiotherapy Planning in the Palliative Setting in Malignant Pleural Mesothelioma; an Exploratory Study
Nicholas Mac Leod (2015)
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