title: Role of FDG-PET in the implementation of involved-node radiation therapy for Hodgkin lymphoma patients.
abstract: OBJECTIVE
  This study examines the role of (18)F-labeled fluorodeoxyglucose positron emission tomography (FDG-PET) in the implementation of involved-node radiation therapy (INRT) in patients treated for clinical stages (CS) I/II supradiaphragmatic Hodgkin lymphoma (HL).
  
  
  METHODS
  Patients with untreated CS I/II HL enrolled in the randomized EORTC/LYSA/FIL Intergroup H10 trial and participating in a real-time prospective quality assurance program were prospectively included in this study. Data were electronically obtained from 18 French cancer centers. All patients underwent APET-computed tomography (PET-CT) and a post-chemotherapy planning CT scanning. The pre-chemotherapy gross tumor volume (GTV) and the postchemotherapy clinical target volume (CTV) were first delineated on CT only by the radiation oncologist. The planning PET was then co-registered, and the delineated volumes were jointly analyzed by the radiation oncologist and the nuclear medicine physician. Lymph nodes undetected on CT but FDG-avid were recorded, and the previously determined GTV and CTV were modified according to FDG-PET results.
  
  
  RESULTS
  From March 2007 to February 2010, 135 patients were included in the study. PET-CT identified at least 1 additional FDG-avid lymph node in 95 of 135 patients (70.4%; 95% confidence interval [CI]: 61.9%-77.9%) and 1 additional lymph node area in 55 of 135 patients (40.7%; 95% CI: 32.4%-49.5%). The mean increases in the GTV and CTV were 8.8% and 7.1%, respectively. The systematic addition of PET to CT led to a CTV increase in 60% of the patients.
  
  
  CONCLUSIONS
  Pre-chemotherapy FDG-PET leads to significantly better INRT delineation without necessarily increasing radiation volumes.
authors.affiliation: Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France.
authors.forename: Théodore
authors.initials: T
authors.lastname: Girinsky
authors.affiliation: Department of Biostatistics and Epidemiology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Aupérin
authors.affiliation: Department of Medicine, Institut Gustave Roussy, Villejuif, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ribrag
authors.affiliation: Department of Imaging, Institut Gustave Roussy, Villejuif, France.
authors.forename: Manel
authors.initials: M
authors.lastname: Elleuch
authors.affiliation: Department of Medicine, Institut Gustave Roussy, Villejuif, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Fermé
authors.affiliation: Department of Medical Physics, Institut Gustave Roussy, Villejuif, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bonniaud
authors.affiliation: Department of Information Technology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Ruelle
authors.affiliation: Department of Imaging, Institut Curie R. Huguenin Hospital, Saint-Cloud, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Alberini
authors.affiliation: Department of Biostatistics and Epidemiology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Aljosa
authors.initials: A
authors.lastname: Celebic
authors.affiliation: Department of Imaging, Institut Curie R. Huguenin Hospital, Saint-Cloud, France. Electronic address: veronique.edeline@curie.fr.
authors.forename: Véronique
authors.initials: V
authors.lastname: Edeline
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D016001:Confidence Intervals; D003606:Dacarbazine / Q000008:administration & dosage; D003964:Diaphragm; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D015182:Lymphatic Irradiation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden; D014747:Vinblastine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin