FDG-PET/CT-guided intensity modulated head and neck radiotherapy

A pilot investigation

David Schwartz, Eric C. Ford, Joseph Rajendran, Bevan Yueh, Marc D. Coltrera, Jeffery Virgin, Yoshimi Anzai, David Haynor, Barbara Lewellen, David Mattes, Paul Kinahan, Juergen Meyer, Mark Phillips, Michael LeBlanc, Kenneth Krohn, Janet Eary, George E. Laramore

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

Background. 2-deoxy-2[18F]fluoro-D-glucose-positron emission tomography (FDG-PET) imaging can be registered with CT images and can potentially improve neck staging sensitivity and specificity in patients with head and neck squamous cell cancer. The intent of this study was to examine the use of registered FDG-PET/CT imaging to guide head and neck intensity modulated radiotherapy (IMRT) planning. Methods. Twenty patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx underwent FDG-PET and contrast-enhanced CT imaging of the head and neck before neck dissection surgery. Combined FDG-PET/CT images were created by use of a nonrigid image registration algorithm. All IMRT plans were theoretical and were not used for treatment. We prescribed 66 Gy in 30 fractions to FDG-avid CT abnormalities and nodal zones directly involved with disease, without prophylactic coverage of uninvolved neck levels. Matched CT-guided IMRT plans designed according to the specifications of Radiation Therapy Oncology Group (RTOG) H-0022 were available for comparison. We investigated the feasibility of FDG-PET/CT-directed IMRT dose escalation in five patients with FDG-avid disease located away from critical normal structures. After 66 Gy, FDG-avid disease with 0.5-cm margins was boosted in 220 cGy increments until dose-limiting criteria were reached. Results. Elimination of prophylactic coverage to FDG-PET/ CT-negative neck levels markedly reduced mean dose (Dmean) to the contralateral parotid gland (p < .001) and Dmean to the laryngeal cartilage (p = .001). No FDG-PET/CT-directed plan missed pathologically verified nodal disease. During the dose escalation exercise, we successfully increased the dose to 95% of the planning target volume (PTV95%) to a mean of 7490 cGy (range, 7153-8098 cGy). Conclusions. We demonstrate early proof of the principle that FDG-PET/CT-guided IMRT planning can selectively target and intensify treatment of head and neck disease while reducing critical normal tissue doses. Routine clinical use of such planning should not be engaged until the accuracy of FDG-PET/CT is fully validated. Future directions, including refinement of treatment to gross disease and radiologically uninvolved neck nodal levels, are discussed.

Original languageEnglish (US)
Pages (from-to)478-487
Number of pages10
JournalHead and Neck
Volume27
Issue number6
DOIs
StatePublished - Jun 1 2005

Fingerprint

Positron-Emission Tomography
Neck
Radiotherapy
Head
Intensity-Modulated Radiotherapy
Glucose
Laryngeal Cartilages
Squamous Cell Neoplasms
Hypopharynx
Oropharynx
Radiation Oncology
Neck Dissection
Parotid Gland
Fluorodeoxyglucose F18
Head and Neck Neoplasms
Larynx
Mouth
Squamous Cell Carcinoma
Therapeutics
Exercise

All Science Journal Classification (ASJC) codes

  • Otorhinolaryngology

Cite this

Schwartz, D., Ford, E. C., Rajendran, J., Yueh, B., Coltrera, M. D., Virgin, J., ... Laramore, G. E. (2005). FDG-PET/CT-guided intensity modulated head and neck radiotherapy: A pilot investigation. Head and Neck, 27(6), 478-487. https://doi.org/10.1002/hed.20177

FDG-PET/CT-guided intensity modulated head and neck radiotherapy : A pilot investigation. / Schwartz, David; Ford, Eric C.; Rajendran, Joseph; Yueh, Bevan; Coltrera, Marc D.; Virgin, Jeffery; Anzai, Yoshimi; Haynor, David; Lewellen, Barbara; Mattes, David; Kinahan, Paul; Meyer, Juergen; Phillips, Mark; LeBlanc, Michael; Krohn, Kenneth; Eary, Janet; Laramore, George E.

In: Head and Neck, Vol. 27, No. 6, 01.06.2005, p. 478-487.

Research output: Contribution to journalArticle

Schwartz, D, Ford, EC, Rajendran, J, Yueh, B, Coltrera, MD, Virgin, J, Anzai, Y, Haynor, D, Lewellen, B, Mattes, D, Kinahan, P, Meyer, J, Phillips, M, LeBlanc, M, Krohn, K, Eary, J & Laramore, GE 2005, 'FDG-PET/CT-guided intensity modulated head and neck radiotherapy: A pilot investigation', Head and Neck, vol. 27, no. 6, pp. 478-487. https://doi.org/10.1002/hed.20177
Schwartz, David ; Ford, Eric C. ; Rajendran, Joseph ; Yueh, Bevan ; Coltrera, Marc D. ; Virgin, Jeffery ; Anzai, Yoshimi ; Haynor, David ; Lewellen, Barbara ; Mattes, David ; Kinahan, Paul ; Meyer, Juergen ; Phillips, Mark ; LeBlanc, Michael ; Krohn, Kenneth ; Eary, Janet ; Laramore, George E. / FDG-PET/CT-guided intensity modulated head and neck radiotherapy : A pilot investigation. In: Head and Neck. 2005 ; Vol. 27, No. 6. pp. 478-487.
@article{6e99eac7e0fd456b9a2bb6597f4f0ebc,
title = "FDG-PET/CT-guided intensity modulated head and neck radiotherapy: A pilot investigation",
abstract = "Background. 2-deoxy-2[18F]fluoro-D-glucose-positron emission tomography (FDG-PET) imaging can be registered with CT images and can potentially improve neck staging sensitivity and specificity in patients with head and neck squamous cell cancer. The intent of this study was to examine the use of registered FDG-PET/CT imaging to guide head and neck intensity modulated radiotherapy (IMRT) planning. Methods. Twenty patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx underwent FDG-PET and contrast-enhanced CT imaging of the head and neck before neck dissection surgery. Combined FDG-PET/CT images were created by use of a nonrigid image registration algorithm. All IMRT plans were theoretical and were not used for treatment. We prescribed 66 Gy in 30 fractions to FDG-avid CT abnormalities and nodal zones directly involved with disease, without prophylactic coverage of uninvolved neck levels. Matched CT-guided IMRT plans designed according to the specifications of Radiation Therapy Oncology Group (RTOG) H-0022 were available for comparison. We investigated the feasibility of FDG-PET/CT-directed IMRT dose escalation in five patients with FDG-avid disease located away from critical normal structures. After 66 Gy, FDG-avid disease with 0.5-cm margins was boosted in 220 cGy increments until dose-limiting criteria were reached. Results. Elimination of prophylactic coverage to FDG-PET/ CT-negative neck levels markedly reduced mean dose (Dmean) to the contralateral parotid gland (p < .001) and Dmean to the laryngeal cartilage (p = .001). No FDG-PET/CT-directed plan missed pathologically verified nodal disease. During the dose escalation exercise, we successfully increased the dose to 95{\%} of the planning target volume (PTV95{\%}) to a mean of 7490 cGy (range, 7153-8098 cGy). Conclusions. We demonstrate early proof of the principle that FDG-PET/CT-guided IMRT planning can selectively target and intensify treatment of head and neck disease while reducing critical normal tissue doses. Routine clinical use of such planning should not be engaged until the accuracy of FDG-PET/CT is fully validated. Future directions, including refinement of treatment to gross disease and radiologically uninvolved neck nodal levels, are discussed.",
author = "David Schwartz and Ford, {Eric C.} and Joseph Rajendran and Bevan Yueh and Coltrera, {Marc D.} and Jeffery Virgin and Yoshimi Anzai and David Haynor and Barbara Lewellen and David Mattes and Paul Kinahan and Juergen Meyer and Mark Phillips and Michael LeBlanc and Kenneth Krohn and Janet Eary and Laramore, {George E.}",
year = "2005",
month = "6",
day = "1",
doi = "10.1002/hed.20177",
language = "English (US)",
volume = "27",
pages = "478--487",
journal = "Head and Neck",
issn = "1043-3074",
publisher = "John Wiley and Sons Inc.",
number = "6",

}

TY - JOUR

T1 - FDG-PET/CT-guided intensity modulated head and neck radiotherapy

T2 - A pilot investigation

AU - Schwartz, David

AU - Ford, Eric C.

AU - Rajendran, Joseph

AU - Yueh, Bevan

AU - Coltrera, Marc D.

AU - Virgin, Jeffery

AU - Anzai, Yoshimi

AU - Haynor, David

AU - Lewellen, Barbara

AU - Mattes, David

AU - Kinahan, Paul

AU - Meyer, Juergen

AU - Phillips, Mark

AU - LeBlanc, Michael

AU - Krohn, Kenneth

AU - Eary, Janet

AU - Laramore, George E.

PY - 2005/6/1

Y1 - 2005/6/1

N2 - Background. 2-deoxy-2[18F]fluoro-D-glucose-positron emission tomography (FDG-PET) imaging can be registered with CT images and can potentially improve neck staging sensitivity and specificity in patients with head and neck squamous cell cancer. The intent of this study was to examine the use of registered FDG-PET/CT imaging to guide head and neck intensity modulated radiotherapy (IMRT) planning. Methods. Twenty patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx underwent FDG-PET and contrast-enhanced CT imaging of the head and neck before neck dissection surgery. Combined FDG-PET/CT images were created by use of a nonrigid image registration algorithm. All IMRT plans were theoretical and were not used for treatment. We prescribed 66 Gy in 30 fractions to FDG-avid CT abnormalities and nodal zones directly involved with disease, without prophylactic coverage of uninvolved neck levels. Matched CT-guided IMRT plans designed according to the specifications of Radiation Therapy Oncology Group (RTOG) H-0022 were available for comparison. We investigated the feasibility of FDG-PET/CT-directed IMRT dose escalation in five patients with FDG-avid disease located away from critical normal structures. After 66 Gy, FDG-avid disease with 0.5-cm margins was boosted in 220 cGy increments until dose-limiting criteria were reached. Results. Elimination of prophylactic coverage to FDG-PET/ CT-negative neck levels markedly reduced mean dose (Dmean) to the contralateral parotid gland (p < .001) and Dmean to the laryngeal cartilage (p = .001). No FDG-PET/CT-directed plan missed pathologically verified nodal disease. During the dose escalation exercise, we successfully increased the dose to 95% of the planning target volume (PTV95%) to a mean of 7490 cGy (range, 7153-8098 cGy). Conclusions. We demonstrate early proof of the principle that FDG-PET/CT-guided IMRT planning can selectively target and intensify treatment of head and neck disease while reducing critical normal tissue doses. Routine clinical use of such planning should not be engaged until the accuracy of FDG-PET/CT is fully validated. Future directions, including refinement of treatment to gross disease and radiologically uninvolved neck nodal levels, are discussed.

AB - Background. 2-deoxy-2[18F]fluoro-D-glucose-positron emission tomography (FDG-PET) imaging can be registered with CT images and can potentially improve neck staging sensitivity and specificity in patients with head and neck squamous cell cancer. The intent of this study was to examine the use of registered FDG-PET/CT imaging to guide head and neck intensity modulated radiotherapy (IMRT) planning. Methods. Twenty patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx underwent FDG-PET and contrast-enhanced CT imaging of the head and neck before neck dissection surgery. Combined FDG-PET/CT images were created by use of a nonrigid image registration algorithm. All IMRT plans were theoretical and were not used for treatment. We prescribed 66 Gy in 30 fractions to FDG-avid CT abnormalities and nodal zones directly involved with disease, without prophylactic coverage of uninvolved neck levels. Matched CT-guided IMRT plans designed according to the specifications of Radiation Therapy Oncology Group (RTOG) H-0022 were available for comparison. We investigated the feasibility of FDG-PET/CT-directed IMRT dose escalation in five patients with FDG-avid disease located away from critical normal structures. After 66 Gy, FDG-avid disease with 0.5-cm margins was boosted in 220 cGy increments until dose-limiting criteria were reached. Results. Elimination of prophylactic coverage to FDG-PET/ CT-negative neck levels markedly reduced mean dose (Dmean) to the contralateral parotid gland (p < .001) and Dmean to the laryngeal cartilage (p = .001). No FDG-PET/CT-directed plan missed pathologically verified nodal disease. During the dose escalation exercise, we successfully increased the dose to 95% of the planning target volume (PTV95%) to a mean of 7490 cGy (range, 7153-8098 cGy). Conclusions. We demonstrate early proof of the principle that FDG-PET/CT-guided IMRT planning can selectively target and intensify treatment of head and neck disease while reducing critical normal tissue doses. Routine clinical use of such planning should not be engaged until the accuracy of FDG-PET/CT is fully validated. Future directions, including refinement of treatment to gross disease and radiologically uninvolved neck nodal levels, are discussed.

UR - http://www.scopus.com/inward/record.url?scp=20044363992&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=20044363992&partnerID=8YFLogxK

U2 - 10.1002/hed.20177

DO - 10.1002/hed.20177

M3 - Article

VL - 27

SP - 478

EP - 487

JO - Head and Neck

JF - Head and Neck

SN - 1043-3074

IS - 6

ER -