1. Integrating respiratory-gated PET-based target volume delineation in liver SBRT planning, a pilot study
- Author
-
Benoit Paulmier, Pascal Fenoglietto, Cécile Ortholan, Olivier Riou, Antonella Artenie, Rémy Villeneuve, Marc Faraggi, Benjamin Serrano, David Azria, and Juliette Thariat
- Subjects
Male ,medicine.medical_specialty ,Respiratory-Gated Imaging Techniques ,Radiotherapy planning ,Stereotactic body radiation therapy ,medicine.medical_treatment ,Planning target volume ,Computed tomography ,Pilot Projects ,Radiosurgery ,Liver metastases ,Imaging, Three-Dimensional ,Neoplasms ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,4D PET ,Prospective Studies ,Aged ,Neoplasm Staging ,SBRT ,medicine.diagnostic_test ,business.industry ,Phantoms, Imaging ,Radiotherapy Planning, Computer-Assisted ,Research ,Liver Neoplasms ,Radiotherapy Dosage ,Middle Aged ,Prognosis ,Tumor Burden ,Respiratory-gated PET ,Radiation therapy ,Oncology ,Radiology Nuclear Medicine and imaging ,Positron emission tomography ,Positron-Emission Tomography ,Female ,Radiology ,Tomography ,Radiotherapy, Intensity-Modulated ,business ,Nuclear medicine ,Tomography, X-Ray Computed ,Emission computed tomography ,Follow-Up Studies - Abstract
Background To assess the feasibility and benefit of integrating four-dimensional (4D) Positron Emission Tomography (PET) – computed tomography (CT) for liver stereotactic body radiation therapy (SBRT) planning. Methods 8 patients with 14 metastases were accrued in the study. They all underwent a non-gated PET and a 4D PET centered on the liver. The same CT scan was used for attenuation correction, registration, and considered the planning CT for SBRT planning. Six PET phases were reconstructed for each 4D PET. By applying an individualized threshold to the 4D PET, a Biological Internal Target Volume (BITV) was generated for each lesion. A gated Planning Target Volume (PTVg) was created by adding 3 mm to account for set-up margins. This volume was compared to a manual Planning Target Volume (PTV) delineated with the help of a semi-automatic Biological Target Volume (BTV) obtained from the non-gated exam. A 5 mm radial and a 10 mm craniocaudal margins were applied to account for tumor motion and set-up margins to create the PTV. Results One undiagnosed liver metastasis was discovered thanks to the 4D PET. The semi-automatic BTV were significantly smaller than the BITV (p = 0.0031). However, after applying adapted margins, 4D PET allowed a statistically significant decrease in the PTVg as compared to the PTV (p = 0.0052). Conclusions In comparison to non-gated PET, 4D PET may better define the respiratory movements of liver targets and improve SBRT planning for liver metastases. Furthermore, non respiratory-gated PET exams can both misdiagnose liver metastases and underestimate the real internal target volumes.
- Published
- 2014