MAESTRO Jan. 2007 PET and Radiotherapy for Head and Neck Cancer: today and tomorrow… Vincent GREGOIRE, M.D., Ph.D. Head and Neck Oncology Program, Radiation Oncology Dept., & Center for Molecular Imaging and Experimental Radiotherapy, Université Catholique de Louvain, St-Luc University Hospital, Brussels, Belgium
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MAESTROJan. 2007
PET and Radiotherapy for Head andNeck Cancer: today and tomorrow…
Vincent GREGOIRE, M.D., Ph.D.
Head and Neck Oncology Program, RadiationOncology Dept., & Center for Molecular Imaging
and Experimental Radiotherapy, UniversitéCatholique de Louvain, St-Luc University
Hospital, Brussels, Belgium
MAESTROJan. 2007
S / RxTh / CH
Work-up-stagingprognostic evaluation
GTV/CTVSelection/delineation
Final responseevaluation
Early responseevaluation
Functional Image-guidedIMRT
Early detectionof recurrence
FDGC-methionineEF3 - F-miso - CuATSMBFU - FLT…
Potential added-value of PET in oncology
MAESTROJan. 2007
Imaging in radiotherapy:… today and tomorrow …
•Selection of Target Volumes with FDG-PET
•Delineation of GTV with FDG-PET
•Selection / delineation of CTV
MAESTROJan. 2007
The use of FDG-PET for the selection ofTarget Volume: setting the scene
Q: unilateral vs bilateralneck irradiation?
A: highly sensitiveexamination
Laryngeal SCC: T2-N1-M0
MAESTROJan. 2007
Detection of metastatic disease in the neck
• N=106 patients
• oral cavity tumors
• Neck dissection for all patients (2196 lymph nodes)
Stuckensen et al., 2000
Sensitivity Specificity Accuracy NPV PPV
PET 70% 82% 75% 71% 81%
CT 66% 69% 70% 66% 74%
MRI 64% 69% 66% 62% 71%
US 84% 68% 76% 79% 75%
MAESTROJan. 2007
Potential added-value of PET in oncology
Grégoire, 2004
Comparison between CT and FDG-PET for nodal staging.
Site Sensitivity Specificity
CT FDG-PET CT FDG-PET
Head and neck cancer 36-86% 50-96% 56-100% 88-100%
NSC lung cancer 45% 80-90% 85% 85-100%
Cervix carcinoma 57-73%1 75-91% 83-100%1 92-100%
Esophageal cancer 11-87% 30-78% 28-99% 86-98%1CT or MRI
MAESTROJan. 2007
Potential added-value of PET in oncology
Antoch et al., 2004
Sensitivity (%) Specificity (%) PPV NPV
PET/CT 92 93 88 94
PET+CT 88 89 83 92
PET 85 88 82 90
CT 64 83 70 79
Comparison between PET and PET/CT for N staging (n=260)
MAESTROJan. 2007
Target
J. John, 1974
MAESTROJan. 2007
The Gross Tumor volume (GTV)
Daisne et al., Radiology, 233: 93-100, 2004
MAESTROJan. 2007 Daisne et al, 2004
The Gross Tumor volume (GTV)
MAESTROJan. 2007
From PET image to tumor: a fixed threshold?
55.917.226.5*13.3mean
56.53039.924.3967.528.341.815.485925.535.917.37
43.26.69.78.6670.919.237.95.65575.384.14
38.621.729.730.9355.76.710.95.2255.111.823.38.31
50%40%SurgicalSpecimen
Patient
GTV (ml)
Geets et al, 2006
MAESTROJan. 2007
Volume delineation based on automatic thresholding with 18F-FDG
•• 10 patients with stage III10 patients with stage III--IVIV pharyngopharyngo--laryngeallaryngeal SCC treated by CTSCC treated by CT--RTRT•• Images acquired before R/ and during RT after means doses of 14,Images acquired before R/ and during RT after means doses of 14, 25, 3525, 35
((surgical specimen is frozensurgical specimen is frozen,,slicedsliced,,digitizeddigitized,, delineateddelineated,, and registredand registred)) 16.6**16.6**24.7*24.7*14.714.7meanmean
27.827.833.433.430.930.977
252534.134.124.324.366
25.325.335.435.417.317.355
19.719.737.237.215.415.444
8.28.216.316.35.65.633
5.55.57.47.45.25.222
4.74.78.78.74.14.111
GradientGradient--basedbasedmethodmethod
ThresholdThreshold--based methodbased method
SurgicalSurgicalspecimenspecimen
PatientPatientNoNo
* in comparison with surgical specimens, p = 0.014 (Student’s t-test)** in comparison with surgical specimens, p = 0.19 (Student’s t-test)