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• W2326327191 abstract "Dose distribution heterogeneity with uncontrolled hotspots within the tumor is frequent with stereotactic body radiation therapy (SBRT). The aim of this study is to assess for lung SBRT whether a positron emission tomography (PET) with 18F-Fluorodeoxyglucose (FDG) can be used to guide this heterogeneity with volumetric modulated arc therapy (VMAT) and simultaneous integrated boost (SIB) technique. For three patients with stage I lung cancer, a Computed Tomography (CT) simulation and a FDG-PET were performed and registered. The planning target volume was manually defined on CT simulation (PTVCT) whereas the biological target volume (BTV) was defined automatically with the fuzzy locally adaptive Bayesian (FLAB) method on PET data. Two VMAT plans were calculated, the first plan delivered 4 x 12Gy within the PTVCT and the second plan delivered with a SIB 4 x 12Gy and 13.8Gy (115% of the prescribed dose) within the PTVCT and the BTV respectively. The maximum dose within the PTVCT (Dmax PTVCT) had to be inferior to 60Gy (125% of the prescribed dose). Plans were evaluated through: the dose received by 95% and 99% of the PTVCT (D95% and D99%), the Dmax PTVCT, the D2cm (maximal dose at 2cm of the PTVCT), the R50% and R100% (ratios between PTVCT and the 50% and 100% isodoses respectively) and the dice similarity coefficient (DSC) between the isodose 115% and the BTV. DSC = (Iso115% BTV) / (Iso115% BTV). Ideal value of DSC is 1 and allows verifying the location of the 115% isodose. The tumor was located in the left inferior lobe with contact to the chest wall for patient 1, in the middle lobe for patient 2 and in the left upper lobe for patient 3. The mean PTVCT and BTV were 36.7 (12.5) and 6.5 (2.2) cm3 respectively. Both plans led to similar target coverage (similar D95% and D99% of the PTVCT) with same Dmax PTVCT (around 124% of the prescription dose) and similar doses to the OARs. The rapid fall-off of the dose outside the PTVCT, evaluated through the D2cm, R50% and R100%, was equivalent with or without SIB technique. On the other hand, the location of hotspots, evaluated through the DSC, was improved for the SIB plans with a mean DSC of 0.31 and 0.45 for the first and the second plans respectively. Use of PET to guide dose prescription heterogeneity and decrease arbitrary location of hotspots is feasible with VMAT and SIB for lung cancer. These preliminary results have to be confirmed with more patients and confronted to a clinical application. Moreover, other PET tracers more specific than FDG could be evaluated for this dose painting." @default.
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• W2326327191 date "2014-09-01" @default.
• W2326327191 modified "2023-09-27" @default.
• W2326327191 title "Use of FDG-PET to Guide Dose Prescription Heterogeneity in Stereotactic Body Radiation Therapy for Lung Cancers With Volumetric Modulated Arc Therapy: A Study of Feasibility" @default.
• W2326327191 doi "https://doi.org/10.1016/j.ijrobp.2014.05.2565" @default.
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