[18F]FDG-positron emission tomography coregistration with computed tomography scans for radiation treatment planning of lymphoma and hematologic malignancies

Stephanie A. Terezakis, Margie A. Hunt, Alexander Kowalski, Patrick McCann, C. Ross Schmidtlein, Anne Reiner, Mithat Gönen, Assen S. Kirov, Anne Marie Gonzales, Heiko Schöder, Joachim Yahalom

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32 Scopus citations


Purpose: Positron emission-tomography (PET) using 2-[18F]fluoro- 2-deoxyglucose (FDG-PET) increases sensitivity and specificity of disease detection in lymphoma and thus is standard in lymphoma management. This study examines the effects of coregistering FDG-PET and computed tomography (CT) (PET/CT) scans on treatment planning for lymphoma patients. Methods and Materials: Twenty-nine patients (30 positive PET scans) underwent PET/CT treatment planning from July 2004 to February 2007 and were retrospectively studied. For each patient, gross tumor volume was blindly contoured on the CT-only and PET/CT studies by a radiation oncologist. Treatment plans were generated for both the CT-only and PET/CT planning target volumes (PTVs) for all patients. Normal tissue doses and PTV coverage were evaluated using dose - volume histograms for all sites. Results: Thirty-two treatment sites were evaluated. Twenty-one patients had non-Hodgkin lymphoma, 5 patients had Hodgkin lymphoma, and 3 patients had plasma cell neoplasms. Previously undetected FDG-avid sites were identified in 3 patients during PET/CT simulation, resulting in one additional treatment field. Due to unexpected PET/CT simulation findings, 2 patients did not proceed with radiation treatment. The addition of PET changed the volume of 23 sites (72%). The PTV was increased in 15 sites (47%) by a median of 11% (range, 6-40%) and reduced in 8 sites (25%) by a median of 20% (range, 6%-75%). In six (19%) replanned sites, the CT-based treatment plan would not have adequately covered the PTV defined by PET/CT. Conclusions: Incorporation of FDG-PET into CT-based treatment planning for lymphoma patients resulted in considerable changes in management, volume definition, and normal tissue dosimetry for a significant number of patients.

Original languageEnglish (US)
Pages (from-to)615-622
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number3
StatePublished - Nov 1 2011
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by the Lymphoma Foundation and the Sports Foundation Against Cancer . Dr. Terezakis was supported by the Dr. Mortimer J. Lacher Fellowship Fund.


  • [F]FDG-PET
  • Involved field radiation
  • Lymphoma
  • PET/CT radiation planning
  • Target volume definition


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