Bulens P, Thomas M, Deroose CM, Haustermans K. PET imaging in adaptive radiotherapy of gastrointestinal tumors.
THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018;
62:385-403. [PMID:
29869484 DOI:
10.23736/s1824-4785.18.03081-9]
[Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION
Radiotherapy is a cornerstone in the multimodality treatment of several gastrointestinal (GI) tumors. Positron-emission tomography (PET) has an established role in the diagnosis, response assessment and (re-)staging of these tumors. Nevertheless, the value of PET in adaptive radiotherapy remains unclear. This review focuses on the role of PET in adaptive radiotherapy, i.e. during the treatment course and in the delineation process.
EVIDENCE ACQUISITION
The MEDLINE database was searched for the terms ("Radiotherapy"[Mesh] AND "Positron-Emission Tomography"[Mesh] AND one of the site-specific keywords, yielding a total of 1710 articles. After abstract selection, 27 papers were identified for esophageal neoplasms, 1 for gastric neoplasms, 9 for pancreatic neoplasms, 6 for liver neoplasms, 1 for biliary tract neoplasms, none for colonic neoplasms, 15 for rectal neoplasms and 12 for anus neoplasms.
EVIDENCE SYNTHESIS
The use of PET for truly adaptive radiotherapy during treatment for GI tumors has barely been investigated, in contrast to the potential of the PET-defined metabolic tumor volume for optimization of the target volume. The optimized target definition seems useful for treatment individualization such as focal boosting strategies in esophageal, pancreatic and anorectal cancer. Nevertheless, for all GI tumors, further investigation is needed.
CONCLUSIONS
In general, too little data are available to conclude on the role of PET imaging during radiotherapy for ART strategies in GI cancer. On the other hand, based on the available evidence, the use of biological imaging for target volume adaptation seems promising and could pave the road towards individualized treatment strategies.
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