title: Distribution Atlas of Proliferating Bone Marrow in Non-Small Cell Lung Cancer Patients Measured by FLT-PET/CT Imaging, With Potential Applicability in Radiation Therapy Planning.
abstract: OBJECTIVE
  Proliferating bone marrow is exquisitely sensitive to ionizing radiation. Knowledge of its distribution could improve radiation therapy planning to minimize unnecessary marrow exposure and avoid consequential prolonged myelosuppression. [18F]-Fluoro-3-deoxy-3-L-fluorothymidine (FLT)-positron emission tomography (PET) is a novel imaging modality that provides detailed quantitative images of proliferating tissues, including bone marrow. We used FLT-PET imaging in cancer patients to produce an atlas of marrow distribution with potential clinical utility.
  
  
  METHODS
  The FLT-PET and fused CT scans of eligible patients with non-small cell lung cancer (no distant metastases, no prior cytotoxic exposure, no hematologic disorders) were reviewed. The proportions of skeletal FLT activity in 10 predefined bony regions were determined and compared according to age, sex, and recent smoking status.
  
  
  RESULTS
  Fifty-one patients were studied: 67% male; median age 68 (range, 31-87) years; 8% never smokers; 70% no smoking in the preceding 3 months. Significant differences in marrow distribution occurred between sex and age groups. No effect was detected from smoking in the preceding 3 months. Using the mean percentages of FLT uptake per body region, we created an atlas of the distribution of functional bone marrow in 4 subgroups defined by sex and age.
  
  
  CONCLUSIONS
  This atlas has potential utility for estimating the distribution of active marrow in adult cancer patients to guide radiation therapy planning. However, because of interindividual variation it should be used with caution when radiation therapy risks ablating large proportions of active marrow; in such cases, individual FLT-PET scans may be required.
authors.affiliation: Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia. Electronic address: Belinda.Campbell@petermac.org.
authors.forename: Belinda A
authors.initials: BA
authors.lastname: Campbell
authors.affiliation: Centre for Molecular Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Callahan
authors.affiliation: Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Mathias
authors.initials: M
authors.lastname: Bressel
authors.affiliation: Centre for Molecular Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Simoens
authors.affiliation: Radiotherapy Services, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Everitt
authors.affiliation: Centre for Molecular Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Hofman
authors.affiliation: Centre for Molecular Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Hicks
authors.affiliation: Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Burbury
authors.affiliation: Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: MacManus
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000000981:diagnostic imaging* / Q000502:physiology; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging*; D015224:Dideoxynucleosides / Q000008:administration & dosage; D054796:Drug Dosage Calculations; D005260:Female; D005462:Fluorine Radioisotopes / Q000008:administration & dosage; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009928:Organ Specificity / Q000502:physiology; D049268:Positron-Emission Tomography / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D012737:Sex Factors; D012907:Smoking; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D015224:Dideoxynucleosides; D005462:Fluorine Radioisotopes; C002854:alovudine