title: A prospective study of ¹⁸FDG-PET with CT coregistration for radiation treatment planning of lymphomas and other hematologic malignancies.
abstract: OBJECTIVE
  This prospective single-institution study examined the impact of positron emission tomography (PET) with the use of 2-[(18)F] fluoro-2-deoxyglucose and computed tomography (CT) scan radiation treatment planning (TP) on target volume definition in lymphoma.
  
  
  METHODS
  118 patients underwent PET/CT TP during June 2007 to May 2009. Gross tumor volume (GTV) was contoured on CT-only and PET/CT studies by radiation oncologists (ROs) and nuclear medicine physicians (NMPs) for 95 patients with positive PET scans. Treatment plans and dose-volume histograms were generated for CT-only and PET/CT for 95 evaluable sites. Paired t test statistics and Pearson correlation coefficients were used for analysis.
  
  
  RESULTS
  70 (74%) patients had non-Hodgkin lymphoma, 10 (11%) had Hodgkin lymphoma, 12 (10%) had plasma-cell neoplasm, and 3 (3%) had other hematologic malignancies. Forty-three (45%) presented with relapsed/refractory disease. Forty-five (47%) received no prior chemotherapy. The addition of PET increased GTV as defined by ROs in 38 patients (median, 27%; range, 5%-70%) and decreased GTV in 41 (median, 39.5%; range, 5%-80%). The addition of PET increased GTV as defined by NMPs in 27 patients (median, 26.5%; range, 5%-95%) and decreased GTV in 52 (median, 70%; range, 5%-99%). The intraobserver correlation between CT-GTV and PET-GTV was higher for ROs than for NMPs (0.94, P<.01 vs 0.89, P<.01). On the basis of Bland-Altman plots, the PET-GTVs defined by ROs were larger than those defined by NMPs. On evaluation of clinical TPs, only 4 (4%) patients had inadequate target coverage (D95 <95%) of the PET-GTV defined by NMPs.
  
  
  CONCLUSIONS
  Significant differences between the RO and NMP volumes were identified when PET was coregistered to CT for radiation planning. Despite this, the PET-GTV defined by ROs and NMPs received acceptable prescription dose in nearly all patients. However, given the potential for a marginal miss, consultation with an experienced PET reader is highly encouraged when PET/CT volumes are delineated, particularly for questionable lesions and to assure complete and accurate target volume coverage.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Terezakis
authors.affiliation: Department of Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Heiko
authors.initials: H
authors.lastname: Schöder
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kowalski
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Patrick
authors.initials: P
authors.lastname: McCann
authors.affiliation: Department of Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Remy
authors.initials: R
authors.lastname: Lim
authors.affiliation: Department of Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Alla
authors.initials: A
authors.lastname: Turlakov
authors.affiliation: Department of Statistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Chris
authors.initials: C
authors.lastname: Barker
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Anuj
authors.initials: A
authors.lastname: Goenka
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Shona
authors.initials: S
authors.lastname: Lovie
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: yahalomj@mskcc.org.
authors.forename: Joachim
authors.initials: J
authors.lastname: Yahalom
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18; D019337:Hematologic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D054219:Neoplasms, Plasma Cell / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy; D009686:Nuclear Physics; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D018787:Radiation Oncology; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012008:Recurrence; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
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