title: The use of fused PET/CT images for patient selection and radical radiotherapy target volume definition in patients with non-small cell lung cancer: results of a prospective study with mature survival data.
abstract: OBJECTIVE
  This prospective study investigated the impact of radiotherapy (RT)-planning FDG-PET/CT on management of non-small cell lung cancer (NSCLC).
  
  
  METHODS
  Patients still eligible for radical RT after conventional staging underwent RT-planning PET/CT and, if disease was still treatable to 60 Gy, they entered our planning study, where visually-contoured tumour volumes derived with and without PET information were compared. If PET/CT detected advanced disease, palliative therapy was given. Overall survival (OS) for palliative and curative patients was compared.
  
  
  RESULTS
  Of 76 eligible patients, only 50 (66%) received radical chemoRT after PET/CT while 26 (34%) received palliative therapies because PET/CT detected advanced disease. Without PET, FDG-avid tumour would reside outside the planning target volume (PTV) in 36% of radical cases and in 25% <90% of the PTV would have received >95% prescribed dose. OS for all patients was 56.8% and 24.9% at 1 and 4 years, respectively. OS for patients given chemoRT was 77.5% and 35.6% at 1 and 4 years, respectively and was 32% for stage IIIA patients at 4 years. OS for patients treated palliatively was inferior (P<0.001); 16.3% and 4.1% at 1 and 4 years, respectively.
  
  
  CONCLUSIONS
  Planning PET/CT frequently changed management and was associated with excellent survival. Survival data from this study were presented in part at the 2011 World Lung Cancer Conference, Amsterdam and planning data at the 2010 Annual Scientific Meeting of the American Society for Therapeutic Radiology and Oncology, Chicago.
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Australia. michael.macmanus@petermac.org
authors.forename: Michael P
authors.initials: MP
authors.lastname: Mac Manus
authors.forename: Sarah
authors.initials: S
authors.lastname: Everitt
authors.forename: Mike
authors.initials: M
authors.lastname: Bayne
authors.forename: David
authors.initials: D
authors.lastname: Ball
authors.forename: Nikki
authors.initials: N
authors.lastname: Plumridge
authors.forename: David
authors.initials: D
authors.lastname: Binns
authors.forename: Alan
authors.initials: A
authors.lastname: Herschtal
authors.forename: Deborah
authors.initials: D
authors.lastname: Cruickshank
authors.forename: Mathias
authors.initials: M
authors.lastname: Bressel
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Hicks
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging; D018579:Patient Selection; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D011880:Radiotherapy Planning, Computer-Assisted; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden