The application of functional imaging techniques to personalise chemoradiotherapy in upper gastrointestinal malignancies.
Bottom Line: The sensitivity and specificity of FDG-PET to predict treatment response and survival are not currently high enough to inform treatment decisions.FDG-PET improves target volume definition in oesophageal cancer by improving the accuracy of tumour length definition and by improving the nodal staging of patients.The current limitations of published studies prevent integrating imaging-derived parameters into decision making on an individual patient basis.
Affiliation: CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Old Road Campus Research Building, Oxford, UK. Electronic address: email@example.com.Show MeSH
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Mentions: Only one series has looked at the effect of functional imaging on GTV definition in pancreatic cancer. In a cohort of patients with LAPC, a computed tomography-defined GTV was used as the reference volume for comparison with a GTV that was delineated after fusion of the FDG-PET with the planning computed tomography. An SUV ≥42% of SUVmax was used when viewing the FDG-PET. The PET-derived GTV was larger by 29.7%, due to extension of primary tumours and additional nodes. Figures 1 and 2 show the potential benefit of including FDG-PET in radiotherapy planning for LAPC. Figure 3 illustrates one of the potential limitations of FDG-PET in LAPC, namely the failure of FDG uptake to differentiate between tumour glucose metabolism and uptake in inflammatory cells. No published data on the correlation of functional imaging with histopathology have been reported.
Affiliation: CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Old Road Campus Research Building, Oxford, UK. Electronic address: firstname.lastname@example.org.