title: Comparison of CT- and FDG-PET-defined gross tumor volume in intensity-modulated radiotherapy for head-and-neck cancer.
abstract: OBJECTIVE
  To compare the gross tumor volume (GTV) identified on CT to that obtained from fluorodeoxyglucose (FDG) positron emission tomography (PET) and determine the differences in volume and dose coverage of the PET-GTV when the CT-GTV is used for radiotherapy planning.
  
  
  METHODS
  A total of 40 patients with intact squamous cell carcinoma arising in the head-and-neck region underwent intensity-modulated radiotherapy (IMRT) at one department. All patients underwent CT simulation for treatment planning followed by PET-CT in the treatment position. CT simulation images were fused to the CT component of the PET-CT images. The GTV using the CT simulation images was contoured (CT-GTV), as was the GTV based on the PET scan (PET-GTV). The IMRT plans were obtained using the CT-GTV.
  
  
  RESULTS
  The PET-GTV was smaller, the same size, and larger than the CT-GTV in 30 (75%), 3 (8%), and 7 (18%) cases respectively. The median PET-GTV and CT-GTV volume was 20.3 cm(3) (range, 0.2-294) and 37.2 cm(3) (range, 2-456), respectively. The volume of PET-GTV receiving at least 95% of the prescribed dose was 100% in 20 (50%), 95-99% in 10 (25%), 90-94% in 3 (8%), 85-89% in 1 (3%), 80-84% in 2 (5%), 75-79% in 1 (3%), and <75% in 3 (8%) cases. The minimal dose received by 95% of the PET-GTV was >/=100% in 19 (48%), 95-99% in 11 (28%), 90-94% in 5 (13%), 85-89% in 2 (5%), and <75% in 3 (8%) cases.
  
  
  CONCLUSIONS
  The PET-GTV was larger than the CT-GTV in 18% of cases. In approximately 25% of patients with intact head-and-neck cancer treated using IMRT, the volume of PET-GTV receiving at least 95% of the prescribed dose and minimal dose received by 95% of the PET-GTV were less than optimal.
authors.affiliation: Department of Radiation Oncology, Division of Nuclear Medicine and Molecular Imaging, Emory Clinic and Emory University, Atlanta, GA, USA. apaulino@tmh.tmc.edu
authors.forename: Arnold C
authors.initials: AC
authors.lastname: Paulino
authors.forename: Mary
authors.initials: M
authors.lastname: Koshy
authors.forename: Rebecca
authors.initials: R
authors.lastname: Howell
authors.forename: David
authors.initials: D
authors.lastname: Schuster
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Davis
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D003198:Computer Simulation; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000379:methods*; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18