title: Methodologies for localizing loco-regional hypopharyngeal carcinoma recurrences in relation to FDG-PET positive and clinical radiation therapy target volumes.
abstract: BACKGROUND
  Focal methods to determine the source of recurrence are presented, tested for reproducibility and compared to volumetric approaches with respect to the number of recurrences ascribed to the FDG-PET positive and high dose volumes.
  
  
  METHODS
  Six patients treated for hypopharyngeal squamous cell carcinoma were extracted from archives. Inclusion criteria were: FDG-PET/CT for primary radiotherapy planning and clinical complete remission followed by loco-regional relapse. CT scan at the time of recurrence was also required. The recurrence volume was delineated in the follow-up scans by a radiologist. Putative points of origin (PO) of the recurrence were determined by two strategies 1) defined by an oncologist or 2) as the center-of-volume (COV) of the recurrence. The most likely recurrence point of origin on the treatment planning scan was also determined. All expert based points of origin were repeated to estimate reproducibility. The recurrence volume and PO were propagated to the treatment planning scan using a rigid transformation. Relations of the PO to target volumes, radiation doses and therapy-points-of-origin were quantified. For the volumetric methods, the overlap of the recurrence volume and target volumes was used to determine the source of the recurrence.
  
  
  RESULTS
  All recurrences were located in-field, but the volumetric approaches tended to designate fewer recurrences in the PET positive volume (25% for the 95% threshold, 95% confidence interval (CI):3-65%) than the observer-based methods (50% for the COV and both expert evaluations on the recurrence scan, 95% CI: 16-84%). The reproducibility of the expert POs is better on the recurrence scan than on the therapy scan.
  
  
  CONCLUSIONS
  Volumetric approaches favor large target volumes as the source of the recurrence, thus underestimating the number of recurrences originating in the PET positive volume. Expert based and COV approaches on the recurrence scan are the most reproducible methods to determine the PO.
authors.affiliation: Department of Radiation Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. anne.kirkebjerg.due@rh.regionh.dk
authors.forename: Anne Kirkebjerg
authors.initials: AK
authors.lastname: Due
authors.forename: Stine
authors.initials: S
authors.lastname: Korreman
authors.forename: Søren M
authors.initials: SM
authors.lastname: Bentzen
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Tomé
authors.forename: Edward
authors.initials: E
authors.lastname: Bender
authors.forename: Marianne
authors.initials: M
authors.lastname: Aznar
authors.forename: Ivan
authors.initials: I
authors.lastname: Vogelius
authors.forename: Anne K
authors.initials: AK
authors.lastname: Berthelsen
authors.forename: Claus A
authors.initials: CA
authors.lastname: Kristensen
authors.forename: Lena
authors.initials: L
authors.lastname: Specht
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D049268:Positron-Emission Tomography / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods; D047368:Tumor Burden
chemical_list: D019788:Fluorodeoxyglucose F18