PET/CT Simulation for Radiation Therapy Planning

Abstract

18F-FDG PET/CT has an important role in radiation therapy planning. FDG PET/CT parameters such as standard uptake value and metabolic tumor volume provide important prognostic and predictive information. Importantly, FDG PET/CT for radiation planning has added biological information in defining the gross tumor volume (GTV) as well as involved nodal disease. Several studies have shown that PET has an impact on radiation therapy planning in an important proportion of patients.

On the other hands, FDG PET/CT for radiation therapy planning has several limitations. First of all, the method to determine the optimal threshold of FDG PET/CT images that generates the best volumetric match to GTV is not established. The size of the GTV derived from FDG accumulation changes significantly depending on the threshold value, the threshold value can affect the clinical target delineation. Secondly, FDG is not a cancer-specific agent, and false positive findings in benign diseases have been reported. PET/CT simulation for radiation therapy planning requires cooperation of other professions and sufficient physical assessment.