Document Detail

Feasibility of optimizing the dose distribution in lung tumors using fluorine-18-fluorodeoxyglucose positron emission tomography and single photon emission computed tomography guided dose prescriptions.
MedLine Citation:
PMID:  15259648     Owner:  NLM     Status:  MEDLINE    
The information provided by functional images may be used to guide radiotherapy planning by identifying regions that require higher radiation dose. In this work we investigate the dosimetric feasibility of delivering dose to lung tumors in proportion to the fluorine-18-fluorodeoxyglucose activity distribution from positron emission tomography (FDG-PET). The rationale for delivering dose in proportion to the tumor FDG-PET activity distribution is based on studies showing that FDG uptake is correlated to tumor cell proliferation rate, which is shown to imply that this dose delivery strategy is theoretically capable of providing the same duration of local control at all voxels in tumor. Target dose delivery was constrained by single photon emission computed tomography (SPECT) maps of normal lung perfusion, which restricted irradiation of highly perfused lung and imposed dose-function constraints. Dose-volume constraints were imposed on all other critical structures. All dose-volume/function constraints were considered to be soft, i.e., critical structure doses corresponding to volume/function constraint levels were minimized while satisfying the target prescription, thus permitting critical structure doses to minimally exceed dose constraint levels. An intensity modulation optimization methodology was developed to deliver this radiation, and applied to two lung cancer patients. Dosimetric feasibility was assessed by comparing spatially normalized dose-volume histograms from the nonuniform dose prescription (FDG-PET proportional) to those from a uniform dose prescription with equivalent tumor integral dose. In both patients, the optimization was capable of delivering the nonuniform target prescription with the same ease as the uniform target prescription, despite SPECT restrictions that effectively diverted dose from high to low perfused normal lung. In one patient, both prescriptions incurred similar critical structure dosages, below dose-volume/function limits. However, in the other patient, critical structure dosage from the nonuniform dose prescription exceeded dose-volume/function limits, and greatly exceeded that from the uniform dose prescription. Strict compliance to dose-volume/ function limits would entail reducing dose proportionality to the FDG-PET activity distribution, thereby theoretically reducing the duration of local control. Thus, even though it appears feasible to tailor lung tumor dose to the FDG-PET activity distribution, despite SPECT restrictions, strict adherence to dose-volume/function limits could compromise the effectiveness of functional image guided radiotherapy.
S K Das; M M Miften; S Zhou; M Bell; M T Munley; C S Whiddon; O Craciunescu; A H Baydush; T Wong; J G Rosenman; M W Dewhirst; L B Marks
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Medical physics     Volume:  31     ISSN:  0094-2405     ISO Abbreviation:  Med Phys     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-07-19     Completed Date:  2005-01-14     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0425746     Medline TA:  Med Phys     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1452-61     Citation Subset:  IM    
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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MeSH Terms
Biophysical Phenomena
Fluorodeoxyglucose F18 / diagnostic use
Lung Neoplasms / radiography,  radionuclide imaging,  radiotherapy*
Positron-Emission Tomography
Radiotherapy Planning, Computer-Assisted* / statistics & numerical data
Tomography, Emission-Computed, Single-Photon
Tomography, X-Ray Computed
Grant Support
Reg. No./Substance:
63503-12-8/Fluorodeoxyglucose F18

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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