title: Effects of radiotherapy planning with a dedicated combined PET-CT-simulator of patients with non-small cell lung cancer on dose limiting normal tissues and radiation dose-escalation: a planning study.
abstract: OBJECTIVE
  To investigate the effect of radiotherapy planning with a dedicated combined PET-CT simulator of patients with locally advanced non-small cell lung cancer.
  
  
  METHODS
  Twenty-one patients underwent a pre-treatment simulation on a dedicated hybrid PET-CT-simulator. For each patient, two 3D conformal treatment plans were made: one with a CT based PTV and one with a PET-CT based PTV, both to deliver 60Gy in 30 fractions. The maximum tolerable prescribed radiation dose for CT versus PET-CT PTV was calculated based on constraints for the lung, the oesophagus, and the spinal cord, and the Tumour Control Probability (TCP) was estimated.
  
  
  RESULTS
  For the same toxicity levels of the lung, oesophagus and spinal cord, the dose could be increased from 55.2+/-2.0Gy with CT planning to 68.9+/-3.3Gy with the use of PET-CT (P=0.002), with corresponding TCP's of 6.3+/-1.5% for CT and 24.0+/-5.6% for PET-CT planning (P=0.01).
  
  
  CONCLUSIONS
  The use of a combined dedicated PET-CT-simulator reduced radiation exposure of the oesophagus and the lung, and thus allowed significant radiation dose escalation whilst respecting all relevant normal tissue constraints.
authors: Department of Radiation Oncology (MAASTRO), Maastricht, The Netherlands. dirk.deruysscher@maastro.nl
authors: Dirk
authors: D
authors: De Ruysscher
authors: Stofferinus
authors: S
authors: Wanders
authors: Andre
authors: A
authors: Minken
authors: Aniek
authors: A
authors: Lumens
authors: Jacqueline
authors: J
authors: Schiffelers
authors: Cissie
authors: C
authors: Stultiens
authors: Serve
authors: S
authors: Halders
authors: Liesbeth
authors: L
authors: Boersma
authors: Angela van
authors: Av
authors: Baardwijk
authors: Tom
authors: T
authors: Verschueren
authors: Monique
authors: M
authors: Hochstenbag
authors: Gabriel
authors: G
authors: Snoep
authors: Brad
authors: B
authors: Wouters
authors: Sebastiaan
authors: S
authors: Nijsten
authors: Søren M
authors: SM
authors: Bentzen
authors: Marinus van
authors: Mv
authors: Kroonenburgh
authors: Michel
authors: M
authors: Ollers
authors: Philippe
authors: P
authors: Lambin
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D004307:Dose-Response Relationship, Radiation; D004941:Esophagitis / Q000517:prevention & control; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography; D011832:Radiation Injuries / Q000517:prevention & control; D020266:Radiotherapy, Conformal / Q000379:methods*; D014057:Tomography, X-Ray Computed