26
|
Brocken P, van der Heijden EHFM, Oud KTM, Bootsma G, Groen HJM, Donders ART, Dekhuijzen PNR, Prins JB. Distress in suspected lung cancer patients following rapid and standard diagnostic programs: a prospective observational study. Psychooncology 2014; 24:433-41. [DOI: 10.1002/pon.3660] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 07/14/2014] [Accepted: 08/01/2014] [Indexed: 11/12/2022]
|
27
|
Chung C, Li W, Bootsma G, Cho Y, von Schultz O, Carlsson P, Jaffray D. Clinical Evaluation of a Novel Thermoplastic Mask System With Intrafraction Motion Monitoring Using IR Tracking and Cone Beam CT for Gamma Knife Radiosurgery. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
28
|
Reymen B, van Baardwijk A, Wanders R, Borger J, Dingemans AMC, Bootsma G, Pitz C, Lunde R, Geraedts W, Lambin P, De Ruysscher D. Long-term survival of stage T4N0-1 and single station IIIA-N2 NSCLC patients treated with definitive chemo-radiotherapy using individualised isotoxic accelerated radiotherapy (INDAR). Radiother Oncol 2014; 110:482-7. [PMID: 24444527 DOI: 10.1016/j.radonc.2013.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 12/10/2013] [Accepted: 12/18/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) stage T4N0-1 or single nodal station IIIA-N2 are two stage III sub-groups for which the outcome of non-surgical therapy is not well known. We investigated the results of individualised isotoxic accelerated radiotherapy (INDAR) and chemotherapy in this setting. METHODS Analysis of NSCLC patients included in 2 prospective trials (NCT00573040 and NCT00572325) stage T4N0-1 or IIIA-N2 with 1 pathologic nodal station, treated with chemo-radiotherapy (CRT) using INDAR with concurrent or sequential platinum-based chemotherapy. Overall survival (OS) was updated and calculated from date of diagnosis (Kaplan-Meier). Toxicity was scored following CTCAEv3.0. To allow comparison with other articles the subgroups were also analysed separately for toxicity, progression free and overall survival. RESULTS 83 patients (42 T4N0-1 and 41 IIIA-N2) were identified: the median radiotherapy dose was 65Gy. Thirty-seven percent of patients received sequential CRT and 63% received concurrent CRT. At a median follow-up of 48 months the median OS for T4N0-1 patients was 34 months with 55% 2-year survival and 25% 5-year survival. For stage IIIA-N2 at a median follow-up of 50 months the median OS was 26 months with 2- and 5-year survival rates of 53% and 24%, respectively. CONCLUSION Chemo-radiation using INDAR yields promising survival results in patients with single-station stage IIIA-N2 or T4N0-1 NSCLC.
Collapse
|
29
|
Troquay S, von Meyenfeldt E, Vissers Y, Bootsma G, Siebenga J. P-141CHEST X-RAY PRIOR TO DISCHARGE AFTER VIDEO-ASSISTED THORACIC ANATOMICAL PULMONARY RESECTION. FRIEND OR FOE? Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
30
|
Reymen B, Van Loon J, van Baardwijk A, Wanders R, Borger J, Dingemans AMC, Bootsma G, Pitz C, Lunde R, Geraedts W, Lambin P, De Ruysscher D. Total Gross Tumor Volume Is an Independent Prognostic Factor in Patients Treated With Selective Nodal Irradiation for Stage I to III Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2012.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
31
|
De Ruysscher D, van Elmpt W, Wanders R, van Baardwijk A, Dingemans A, Reymen B, Bootsma G, Lambin P, Sonke J, Belderbos J. Acute Toxicity of Full-Dose Cisplatin-Etoposide Concurrently with High-Dose Hypofractionated Chest Radiotherapy for Stage III Non-Small Cell Lung Cancer: Subset Analysis of Non-Randomised Patients in the Pet-Boost Phase II Trial (NCT01024829). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33767-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
32
|
Bootsma G, Verhaegen F, Jaffray D. SU-F-BRCD-04: Efficient Scatter Distribution Estimation and Correction in CBCT Using Concurrent Monte Carlo Fitting. Med Phys 2012; 39:3856. [PMID: 28517527 DOI: 10.1118/1.4735742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE X-ray scatter is a known source of image artifacts, contrast reduction, and CT number inaccuracy in cone-beam CT (CBCT). We present and demonstrate the performance of a novel scatter correction method based on an algorithm that simultaneously combines multiple Monte Carlo (MC) CBCT scatter simulations through the use of a fitting function. METHODS AND MATERIALS The scatter estimation system consists of concurrently run MC CBCT scatter projection simulations that are a sub-sample of the projection angles used in the reconstruction projection set, P, to be corrected. The photons generated by each MC simulation are simultaneously aggregated in an algorithm which computes the scatter detector response, S(i,j,k), for each down-sampled projection location (i,j) and angle (k). S(i,j,k) is fit to a function, FS, and if FS is determined to have a specified goodness of fit value the simulations are terminated. FS is subtracted from P which is subsequently used to create a scatter corrected reconstruction. The scatter correction method was applied to simulated phantoms using a frequency limited sum of sines and cosines as the fitting function. Image quality in the corrected reconstruction was evaluated using metrics looking at contrast, noise, and artifact reduction. RESULTS Fitting the scatter distribution to a limited sum of sine and cosine functions, using a low-pass filtered Fast Fourier transform, provides a computationally efficient and accurate fit. Scatter distribution estimates for a 360 image projection set were computed in under one minute. The scatter correction algorithm increased the contrast-to-noise ratio by 46%, reduced the shading artifact by 87%, and decreased the skin line artifact by 79% in reconstructions of a simulated pelvis phantom. CONCLUSION The algorithm provides an efficient method for estimating and removing the scatter distribution in from CBCT projection images. The results on simulated data show a significant increase in image quality.
Collapse
|
33
|
van Baardwijk A, Reymen B, Wanders S, Borger J, Ollers M, Dingemans AMC, Bootsma G, Geraedts W, Pitz C, Lunde R, Peters F, Lambin P, De Ruysscher D. Mature results of a phase II trial on individualised accelerated radiotherapy based on normal tissue constraints in concurrent chemo-radiation for stage III non-small cell lung cancer. Eur J Cancer 2012; 48:2339-46. [PMID: 22608261 DOI: 10.1016/j.ejca.2012.04.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 03/26/2012] [Accepted: 04/09/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sequential chemotherapy and individualised accelerated radiotherapy (INDAR) has been shown to be effective in non-small cell lung cancer (NSCLC), allowing delivering of high biological doses. We therefore performed a phase II trial (clinicaltrials.gov; NCT00572325) investigating the same strategy in concurrent chemo-radiation in stage III NSCLC. METHODS 137 stage III patients fit for concurrent chemo-radiation (PS 0-2; FEV(1) and DLCO ≥ 30%) were included from April 2006 till December 2009. An individualised prescribed dose based on normal tissue dose constraints was applied: mean lung dose (MLD) 19 Gy, spinal cord 54 Gy, brachial plexus 66 Gy, central structures 74 Gy. A total dose between 51 and 69 Gy was delivered in 1.5 Gy BID up to 45 Gy, followed by 2 Gy QD. Radiotherapy was started at the 2nd or 3rd course of chemotherapy. Primary end-point was overall survival (OS) and secondary end-point toxicity common terminology criteria for adverse events v3.0 (CTCAEv3.0). FINDINGS The median tumour volume was 76.4 ± 94.1 cc; 49.6% of patients had N2 and 32.1% N3 disease. The median dose was 65.0 ± 6.0 Gy delivered in 35 ± 5.7 days. Six patients (4.4%) did not complete radiotherapy. With a median follow-up of 30.9 months, the median OS was 25.0 months (2-year OS 52.4%). Severe acute toxicity (≥ G3, 35.8%) consisted mainly of G3 dysphagia during radiotherapy (25.5%). Severe late toxicity (≥ G3) was observed in 10 patients (7.3%). INTERPRETATION INDAR in concurrent chemo-radiation based on normal tissue constraints is feasible, even in patients with large tumour volumes and multi-level N2-3 disease, with acceptable severe late toxicity and promising 2-year survival.
Collapse
|
34
|
De Ruysscher D, van Baardwijk A, Steevens J, Botterweck A, Bosmans G, Reymen B, Wanders R, Borger J, Dingemans AMC, Bootsma G, Pitz C, Lunde R, Geraedts W, Oellers M, Dekker A, Lambin P. Individualised isotoxic accelerated radiotherapy and chemotherapy are associated with improved long-term survival of patients with stage III NSCLC: A prospective population-based study. Radiother Oncol 2012; 102:228-33. [DOI: 10.1016/j.radonc.2011.10.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 10/19/2011] [Accepted: 10/20/2011] [Indexed: 12/25/2022]
|
35
|
Wanders R, Steevens J, Botterweck A, Dingemans AMC, Reymen B, Baardwijk AV, Borger J, Bootsma G, Pitz C, Lunde R, Geraedts W, Lambin P, De Ruysscher D. Treatment with curative intent of stage III non-small cell lung cancer patients of 75years: A prospective population-based study. Eur J Cancer 2011; 47:2691-7. [DOI: 10.1016/j.ejca.2011.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/01/2011] [Accepted: 06/07/2011] [Indexed: 10/18/2022]
|
36
|
van Baardwijk A, Reymen B, Wanders R, Dingemans A, Bootsma G, Pitz C, Lunde R, Geraedts W, Lambin P, De Ruysscher D. Mature Results of a Phase II Trial on Individualized Radiation Dose-escalation Based on Normal Tissue Constraints in Concurrent Chemo-radiation for Stage III Non-small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
37
|
Dingemans A, Bootsma G, van Baardwijk A, Reijmen B, Wanders R, Hochstenbag M, van Belle A, Houben R, Lambin P, de Ruysscher D. 9034 POSTER Determination of Standard Dose Cetuximab Together With Concurrent Individualised, Isotoxic Accelerated Radiotherapy (RT) and Cisplatin-vinorelbine for Patients (pts) With Stage III Non-small Cell Lung Cancer (NSCLC): a Phase I Study (NCT00522886). Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72346-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
38
|
Bootsma G, Verhaegen F, Jaffray D. SU-E-I-116: Spatial Frequency Spectrum of the X-Ray Scatter Distribution in CBCT. Med Phys 2011. [DOI: 10.1118/1.3611690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
39
|
Van Baardwijk A, Wanders R, Reymen B, Borger J, Dingemans A, Bootsma G, Pitz C, Geraedts W, Lambin P, De Ruysscher D. First Results of a Phase II Trial Investigating Individualized Dose-escalation Based on Normal Tissue Constraints in Concurrent Chemo-radiation for Locally Advanced Non-small Cell Lung Cancer (NSCLC) (NCT00572325). Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
40
|
Bootsma G, Verhaegen F, Jaffray D. TH-D-201B-05: Monte Carlo Simulations of the Effects of Bowtie Filtration on X-Ray Scatter in Cone-Beam CT. Med Phys 2010. [DOI: 10.1118/1.3469564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
41
|
van Loon J, Grutters JPC, Wanders R, Boersma L, Dingemans AMC, Bootsma G, Geraedts W, Pitz C, Simons J, Brans B, Snoep G, Hochstenbag M, Lambin P, De Ruysscher D. 18FDG-PET-CT in the follow-up of non-small cell lung cancer patients after radical radiotherapy with or without chemotherapy: an economic evaluation. Eur J Cancer 2010; 46:110-9. [PMID: 19944595 DOI: 10.1016/j.ejca.2009.10.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 10/29/2009] [Indexed: 01/10/2023]
Abstract
BACKGROUND The optimal follow-up strategy of non-small cell lung cancer (NSCLC) patients after curative intent therapy is still not established. In a recent prospective study with 100 patients, we showed that a FDG-PET-CT 3 months after radiotherapy (RT) could identify progression amenable for curative treatment in 2% (95% confidence interval (CI): 1-7%) of patients, who were all asymptomatic. Here, we report on the economic evaluation of this study. PATIENTS AND METHODS A decision-analytic Markov model was developed in which the long-term cost-effectiveness of 3 follow-up strategies was modelled with different imaging methods 3 months after therapy: a PET-CT scan; a chest CT scan; and conventional follow-up with a chest X-ray. A probabilistic sensitivity analysis was performed to account for uncertainty. Because the results of the prospective study indicated that the advantage seems to be confined to asymptomatic patients, we additionally examined a strategy where a PET-CT was applied only in the subgroup of asymptomatic patients. Cost-effectiveness of the different follow-up strategies was expressed in incremental cost-effectiveness ratios (ICERs), calculating the incremental costs per quality adjusted life year (QALY) gained. RESULTS Both PET-CT- and CT-based follow-up were more costly but also more effective than conventional follow-up. CT-based follow-up was only slightly more effective than conventional follow-up, resulting in an incremental cost-effectiveness ratio (ICER) of euro 264.033 per QALY gained. For PET-CT-based follow-up, the ICER was euro 69.086 per QALY gained compared to conventional follow-up. The strategy in which a PET-CT was only performed in the asymptomatic subgroup resulted in an ICER of euro 42.265 per QALY gained as opposed to conventional follow-up. With this strategy, given a ceiling ratio of euro 80.000, PET-CT-based follow-up had the highest probability of being cost-effective (73%). CONCLUSIONS This economic evaluation shows that a PET-CT scan 3 months after (chemo)radiotherapy with curative intent is a potentially cost-effective follow-up method, and is more cost-effective than CT alone. Applying a PET-CT scan only in asymptomatic patients is probably as effective and more cost-effective. It is worthwhile to perform additional research to reduce uncertainty regarding the decision concerning imaging in the follow-up of NSCLC.
Collapse
|
42
|
van Baardwijk A, Wanders S, Boersma L, Borger J, Ollers M, Dingemans AMC, Bootsma G, Geraedts W, Pitz C, Lunde R, Lambin P, De Ruysscher D. Mature results of an individualized radiation dose prescription study based on normal tissue constraints in stages I to III non-small-cell lung cancer. J Clin Oncol 2010; 28:1380-6. [PMID: 20142596 DOI: 10.1200/jco.2009.24.7221] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We previously showed that individualized radiation dose escalation based on normal tissue constraints would allow safe administration of high radiation doses with low complication rate. Here, we report the mature results of a prospective, single-arm study that used this individualized tolerable dose approach. PATIENTS AND METHODS In total, 166 patients with stage III or medically inoperable stage I to II non-small-cell lung cancer, WHO performance status 0 to 2, a forced expiratory volume at 1 second and diffusing capacity of lungs for carbon monoxide >or= 30% were included. Patients were irradiated using an individualized prescribed total tumor dose (TTD) based on normal tissue dose constraints (mean lung dose, 19 Gy; maximal spinal cord dose, 54 Gy) up to a maximal TTD of 79.2 Gy in 1.8 Gy fractions twice daily. Only sequential chemoradiation was administered. The primary end point was overall survival (OS), and the secondary end point was toxicity according to Common Terminology Criteria of Adverse Events (CTCAE) v3.0. RESULTS The median prescribed TTD was 64.8 Gy (standard deviation, +/- 11.4 Gy) delivered in 25 +/- 5.8 days. With a median follow-up of 31.6 months, the median OS was 21.0 months with a 1-year OS of 68.7% and a 2-year OS of 45.0%. Multivariable analysis showed that only a large gross tumor volume significantly decreased OS (P < .001). Both acute (grade 3, 21.1%; grade 4, 2.4%) and late toxicity (grade 3, 4.2%; grade 4, 1.8%) were acceptable. CONCLUSION Individualized prescribed radical radiotherapy based on normal tissue constraints with sequential chemoradiation shows survival rates that come close to results of concurrent chemoradiation schedules, with acceptable acute and late toxicity. A prospective randomized study is warranted to further investigate its efficacy.
Collapse
|
43
|
Cho Y, Bootsma G, Ruschin M, MacFadden D, Hodaie M, Ménard C, Jaffray D. Evaluating Stress-related Uncertainties in Stereotactic Frame-based Localization for Gamma Knife Radiosurgery. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
44
|
Bootsma G, Verhaegen F, Jaffray D. SU-FF-I-111: Exploration of the Scatter Distribution in Cone-Beam CT Using Monte Carlo Techniques. Med Phys 2009. [DOI: 10.1118/1.3181232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
45
|
Nayebi N, Cho Y, Bootsma G, Li W, Ruschin M, Jaffray D. SU-FF-T-532: Immobilization Accuracy of a Novel Re-Locatable Head Frame Investigated with a Real-Time Optical Tracking System. Med Phys 2009. [DOI: 10.1118/1.3182030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
46
|
De Ruysscher D, Dehing C, Yu S, Wanders R, Öllers M, Dingemans AMC, Bootsma G, Hochstenbag M, Geraedts W, Pitz C, Simons J, Boersma L, Borger J, Dekker A, Lambin P. Dyspnea evolution after high-dose radiotherapy in patients with non-small cell lung cancer. Radiother Oncol 2009; 91:353-9. [DOI: 10.1016/j.radonc.2008.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 10/10/2008] [Accepted: 10/12/2008] [Indexed: 11/27/2022]
|
47
|
Siddique S, Bartolac SJ, Bootsma G, Mail N, Fiume E, Jaffray D. SU-FF-I-162: Depth of Field in Radiography. Med Phys 2009. [DOI: 10.1118/1.3181283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
48
|
Ruysscher DD, Dehing C, Dingemans AMC, Bootsma G, Lambin P. In response to the “Letter to the Editor” by Borst et al.: Dyspnea evaluation after high-dose radiotherapy in patients with NSCLC. Radiother Oncol 2009. [DOI: 10.1016/j.radonc.2009.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
49
|
Aerts HJWL, van Baardwijk AAW, Petit SF, Offermann C, Loon JV, Houben R, Dingemans AMC, Wanders R, Boersma L, Borger J, Bootsma G, Geraedts W, Pitz C, Simons J, Wouters BG, Oellers M, Lambin P, Bosmans G, Dekker ALAJ, De Ruysscher D. Identification of residual metabolic-active areas within individual NSCLC tumours using a pre-radiotherapy (18)Fluorodeoxyglucose-PET-CT scan. Radiother Oncol 2009; 91:386-92. [PMID: 19329207 DOI: 10.1016/j.radonc.2009.03.006] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 03/02/2009] [Accepted: 03/04/2009] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Non-small cell lung cancer (NSCLC) tumours are mostly heterogeneous. We hypothesized that areas within the tumour with a high pre-radiation (18)F-deoxyglucose (FDG) uptake, could identify residual metabolic-active areas, ultimately enabling selective-boosting of tumour sub-volumes. MATERIAL AND METHODS Fifty-five patients with inoperable stage I-III NSCLC treated with chemo-radiation or with radiotherapy alone were included. For each patient one pre-radiotherapy and one post-radiotherapy FDG-PET-CT scans were available. Twenty-two patients showing persistent FDG uptake in the primary tumour after radiotherapy were analyzed. Overlap fractions (OFs) were calculated between standardized uptake value (SUV) threshold-based auto-delineations on the pre- and post-radiotherapy scan. RESULTS Patients with residual metabolic-active areas within the tumour had a significantly worse survival compared to individuals with a complete metabolic response (p=0.002). The residual metabolic-active areas within the tumour largely corresponded (OF>70%) with the 50%SUV high FDG uptake area of the pre-radiotherapy scan. The hotspot within the residual area (90%SUV) was completely within the GTV (OF=100%), and had a high overlap with the pre-radiotherapy 50%SUV threshold (OF>84%). CONCLUSIONS The location of residual metabolic-active areas within the primary tumour after therapy corresponded with the original high FDG uptake areas pre-radiotherapy. Therefore, a single pre-treatment FDG-PET-CT scan allows for the identification of residual metabolic-active areas.
Collapse
|
50
|
De Ruysscher D, Botterweck A, Dirx M, Pijls-Johannesma M, Wanders R, Hochstenbag M, Dingemans AMC, Bootsma G, Geraedts W, Simons J, Pitz C, Lambin P. Eligibility for concurrent chemotherapy and radiotherapy of locally advanced lung cancer patients: a prospective, population-based study. Ann Oncol 2009; 20:98-102. [DOI: 10.1093/annonc/mdn559] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|