title: Initial experience of FDG-PET/CT guided IMRT of head-and-neck carcinoma.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the impact of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) fused with planning computed tomography (CT) on tumor localization, which guided intensity-modulated radiotherapy (IMRT) of patients with head-and-neck carcinoma.
  
  
  METHODS
  From October 2002 through April 2005, we performed FDG-PET/CT guided IMRT for 28 patients with head-and-neck carcinoma. Patients were immobilized with face masks that were attached with five fiducial markers. FDG-PET and planning CT scans were performed on the same flattop table in one session and were then fused. Target volumes and critical organs were contoured, and IMRT plans were generated based on the fused images.
  
  
  RESULTS
  All 28 patients had abnormal increased uptake in FDG-PET/CT scans. PET/CT resulted in CT-based staging changes in 16 of 28 (57%) patients. PET/CT fusions were successfully performed and were found to be accurate with the use of the two commercial planning systems. Volume analysis revealed that the PET/CT-based gross target volumes (GTVs) were significantly different from those contoured from the CT scans alone in 14 of 16 patients. In addition, 16 of 28 patients who were followed for more than 6 months did not have any evidence of locoregional recurrence in the median time of 17 months.
  
  
  CONCLUSIONS
  Fused images were found to be useful to delineate GTV required in IMRT planning. PET/CT should be considered for both initial staging and treatment planning in patients with head-and-neck carcinoma.
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53045, USA. dwang@radonc.mcw.edu
authors.forename: Dian
authors.initials: D
authors.lastname: Wang
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Schultz
authors.forename: Paul A
authors.initials: PA
authors.lastname: Jursinic
authors.forename: Mirek
authors.initials: M
authors.lastname: Bialkowski
authors.forename: X Ronald
authors.initials: XR
authors.lastname: Zhu
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Brown
authors.forename: Scott D
authors.initials: SD
authors.lastname: Rand
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Michel
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Campbell
authors.forename: Stuart
authors.initials: S
authors.lastname: Wong
authors.forename: X Allen
authors.initials: XA
authors.lastname: Li
authors.forename: J Frank
authors.initials: JF
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; 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 / Q000379:methods*; D019275:Radiopharmaceuticals; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18