Journal of Medical Imaging and Radiation Oncology

Volume 62, Issue 1 pp. 81-90

Medical Imaging—Radiation Oncology—Original Article

Impact of tumour motion compensation and delineation methods on FDG PET-based dose painting plan quality for NSCLC radiation therapy

Hannah Mary Thomas,

Hannah Mary Thomas

orcid.org/0000-0002-1454-512X

Department of Radiation Oncology, School of Medicine, University of Washington, Seattle, Washington, USA

Department of Physics, School of Advanced Sciences, VIT University, Vellore, India

Search for more papers by this author

Paul E Kinahan,

Paul E Kinahan

Department of Radiology, School of Medicine, University of Washington, Seattle, Washington, USA

Search for more papers by this author

James Jebaseelan E Samuel,

James Jebaseelan E Samuel

Department of Physics, School of Advanced Sciences, VIT University, Vellore, India

Search for more papers by this author

Stephen R Bowen,

Corresponding Author

Stephen R Bowen

[email protected]

Department of Radiation Oncology, School of Medicine, University of Washington, Seattle, Washington, USA

Department of Radiology, School of Medicine, University of Washington, Seattle, Washington, USA

Correspondence

Dr Stephen R Bowen, Departments of Radiology and Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St. Box 356043, Seattle, WA 98195, USA

Email: [email protected]

Search for more papers by this author

Hannah Mary Thomas,

Hannah Mary Thomas

orcid.org/0000-0002-1454-512X

Department of Radiation Oncology, School of Medicine, University of Washington, Seattle, Washington, USA

Department of Physics, School of Advanced Sciences, VIT University, Vellore, India

Search for more papers by this author

Paul E Kinahan,

Paul E Kinahan

Department of Radiology, School of Medicine, University of Washington, Seattle, Washington, USA

Search for more papers by this author

James Jebaseelan E Samuel,

James Jebaseelan E Samuel

Department of Physics, School of Advanced Sciences, VIT University, Vellore, India

Search for more papers by this author

Stephen R Bowen,

Corresponding Author

Stephen R Bowen

[email protected]

Department of Radiation Oncology, School of Medicine, University of Washington, Seattle, Washington, USA

Department of Radiology, School of Medicine, University of Washington, Seattle, Washington, USA

Correspondence

Dr Stephen R Bowen, Departments of Radiology and Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St. Box 356043, Seattle, WA 98195, USA

Email: [email protected]

Search for more papers by this author

First published: 28 November 2017

https://doi.org/10.1111/1754-9485.12693

Citations: 11

HM Thomas PhD; PE Kinahan PhD; JJE Samuel PhD; SR Bowen PhD.

Conflict of interest: None.

Share a link

Email
Wechat
Bluesky

Abstract

Introduction

To quantitatively estimate the impact of different methods for both boost volume delineation and respiratory motion compensation of [18F] FDG PET/CT images on the fidelity of planned non-uniform ‘dose painting’ plans to the prescribed boost dose distribution.

Methods

Six locally advanced non-small cell lung cancer (NSCLC) patients were retrospectively reviewed. To assess the impact of respiratory motion, time-averaged (3D AVG), respiratory phase-gated (4D GATED) and motion-encompassing (4D MIP) PET images were used. The boost volumes were defined using manual contour (MANUAL), fixed threshold (FIXED) and gradient search algorithm (GRADIENT). The dose painting prescription of 60 Gy base dose to the planning target volume and an integral dose of 14 Gy (total 74 Gy) was discretized into seven treatment planning substructures and linearly redistributed according to the relative SUV at every voxel in the boost volume. Fifty-four dose painting plan combinations were generated and conformity was evaluated using quality index VQ0.95–1.05, which represents the sum of planned dose voxels within 5% deviation from the prescribed dose. Trends in plan quality and magnitude of achievable dose escalation were recorded.

Results

Different segmentation techniques produced statistically significant variations in maximum planned dose (P < 0.02), as well as plan quality between segmentation methods for 4D GATED and 4D MIP PET images (P < 0.05). No statistically significant differences in plan quality and maximum dose were observed between motion-compensated PET-based plans (P > 0.75). Low variability in plan quality was observed for FIXED threshold plans, while MANUAL and GRADIENT plans achieved higher dose with lower plan quality indices.

Conclusions

The dose painting plans were more sensitive to segmentation of boost volumes than PET motion compensation in this study sample. Careful consideration of boost target delineation and motion compensation strategies should guide the design of NSCLC dose painting trials.

Supporting Information

References

1Amini A, Lou F, Correa AM et al. Predictors for locoregional recurrence for clinical stage III-N2 non-small cell lung cancer with nodal downstaging after induction chemotherapy and surgery. Ann Surg Oncol 2013; 20: 1934–40.
10.1245/s10434-012-2800-x
PubMed Web of Science® Google Scholar
2Perez CA, Pajak TF, Rubin P et al. Long-term observations of the patterns of failure in patients with unresectable non-oat cell carcinoma of the lung treated with definitive radiotherapy. Report by the radiation therapy oncology group. Cancer 1987; 59: 1874–81.
10.1002/1097-0142(19870601)59:11<1874::AID-CNCR2820591106>3.0.CO;2-Z
CAS PubMed Web of Science® Google Scholar
3Aerts HJWL, Bussink J, Oyen WJG et al. Identification of residual metabolic-active areas within NSCLC tumours using a pre-radiotherapy FDG-PET-CT scan: a prospective validation. Lung Cancer 2012; 75: 73–6.
10.1016/j.lungcan.2011.06.003
PubMed Web of Science® Google Scholar
4Søvik Å, Malinen E, Olsen DR. Strategies for biologic image-guided dose escalation: a review. Int J Radiat Oncol Biol Phys 2009; 73: 650–8.
10.1016/j.ijrobp.2008.11.001
PubMed Web of Science® Google Scholar
5Moller DS, Nielsen TB, Brink C et al. Heterogeneous FDG-guided dose-escalation for locally advanced NSCLC (the NARLAL2 trial): design and early dosimetric results of a randomized, multi-centre phase-III study. Radiother Oncol 2017; 124: 311–7.
10.1016/j.radonc.2017.06.022
PubMed Web of Science® Google Scholar
6van Elmpt W, De Ruysscher D, van der Salm A et al. The PET-boost randomised phase II dose-escalation trial in non-small cell lung cancer. Radiother Oncol 2012; 104: 67–71.
10.1016/j.radonc.2012.03.005
PubMed Web of Science® Google Scholar
7Konert T, Vogel W, MacManus MP et al. PET/CT imaging for target volume delineation in curative intent radiotherapy of non-small cell lung cancer: IAEA consensus report 2014. Radiother Oncol 2015; 116: 27–34.
10.1016/j.radonc.2015.03.014
PubMed Web of Science® Google Scholar
8Hatt M, Visvikis D, Le Rest CC. Autocontouring versus manual contouring. J Nucl Med 2011; 52: 658.
10.2967/jnumed.110.084897
PubMed Web of Science® Google Scholar
9Foster B, Bagci U, Mansoor A, Xu Z, Mollura DJ. A review on segmentation of positron emission tomography images. Comput Biol Med 2014; 50: 76–96.
10.1016/j.compbiomed.2014.04.014
PubMed Web of Science® Google Scholar
10Nelson AD, Werner-Wasik M, Choi W et al. PET tumor segmentation: multi-observer validation of a gradient-based method using a NSCLC PET phantom. Int J Radiat Oncol Biol Phys 2009; 75: 627.
10.1016/j.ijrobp.2009.07.1432
Web of Science® Google Scholar
11Sureshbabu W, Mawlawi O. PET/CT imaging artifacts. J Nucl Med Technol 2005; 33: 156–61.
PubMed Google Scholar
12Adams MC, Turkington TG, Wilson JM, Wong TZ. A systematic review of the factors affecting accuracy of SUV measurements. Am J Roentgenol 2010; 195: 310–20.
10.2214/AJR.10.4923
PubMed Web of Science® Google Scholar
13Liu C, Alessio A, Pierce L et al. Quiescent period respiratory gating for PET/CT. Med Phys 2010; 37: 5037.
10.1118/1.3480508
CAS PubMed Web of Science® Google Scholar
14Chi A, Nguyen NP. 4D PET/CT as a strategy to reduce respiratory motion artifacts in FDG-PET/CT. Radiat Oncol 2014; 4: 205.
Google Scholar
15Alessio A, Kohlmyer S, Kinahan P. Consistency driven respiratory phase alignment and motion compensation in PET/CT. IEEE Nucl Sci Symp Conf Rec 1997; 2007: 3115–9.
Google Scholar
16Werner-Wasik M, Nelson AD, Choi W et al. What is the best way to contour lung tumors on PET scans? Multiobserver validation of a gradient-based method using a NSCLC digital PET phantom. Int J Radiat Oncol Biol Phys 2012; 82: 1164–71.
10.1016/j.ijrobp.2010.12.055
PubMed Web of Science® Google Scholar
17Bradley JD, Moughan J, Graham MV et al. A phase I/II radiation dose escalation study with concurrent chemotherapy for patients with inoperable stages I-III non-small cell lung cancer: the phase I results of RTOG 0117. Int J Radiat Oncol Biol Phys 2010; 77: 367–72.
10.1016/j.ijrobp.2009.04.029
CAS PubMed Web of Science® Google Scholar
18Deveau MA, Bowen SR, Westerly DC, Jeraj R. Feasibility and sensitivity study of helical tomotherapy for dose painting plans. Acta Oncol 2010; 49: 991–6.
10.3109/0284186X.2010.500302
PubMed Web of Science® Google Scholar
19Vanderstraeten B, Duthoy W, Gersem WD, Neve WD, Thierens H. 18F-fluoro-deoxy-glucose positron emission tomography (18F-FDG-PET) voxel intensity-based intensity-modulated radiation therapy (IMRT) for head and neck cancer. Radiother Oncol 2006; 79: 249–58.
10.1016/j.radonc.2006.03.003
CAS PubMed Web of Science® Google Scholar
20Håkansson K, Specht L, Aznar MC, Rasmussen JH, Bentzen SM, Vogelius IR. Prescribing and evaluating target dose in dose-painting treatment plans. Acta Oncol Stockh Swed 2014; 53: 1251–6.
10.3109/0284186X.2014.906747
PubMed Web of Science® Google Scholar
21 International Atomic Energy Agency. The role of PET/CT in radiation treatment planning for cancer patient treatment. International Atomic Energy Agency, Vienna, 2008.
Google Scholar
22Feng M, Kong F-M, Gross M, Fernando S, Hayman JA, Ten Haken RK. Using fluorodeoxyglucose positron emission tomography to assess tumor volume during radiotherapy for non–small-cell lung cancer and its potential impact on adaptive dose escalation and normal tissue sparing. Int J Radiat Oncol 2009; 73: 1228–34.
10.1016/j.ijrobp.2008.10.054
PubMed Web of Science® Google Scholar
23Even AJG, dervan Stoep J, Zegers CML et al. PET-based dose painting in non-small cell lung cancer: comparing uniform dose escalation with boosting hypoxic and metabolically active sub-volumes. Radiother Oncol 2015; 116(2): 281–6.
10.1016/j.radonc.2015.07.013
PubMed Web of Science® Google Scholar
24Machtay M, Matuszak M, Bradley J, Hirsh V, Ten Haken R, Pryma D. Randomized phase II trial of individualized adaptive radiotherapy using during-treatment FDG PET/CT and modern technology in locally advanced non-small cell lung cancer (NSCLC). RTOG 1106/ACRIN 6697 2013: 1–107. [Cited 19 Jan 2015.] Available from URL: http://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?action=openFile&FileID=10848.
Google Scholar
25Lamb JM, Robinson C, Bradley J et al. Generating lung tumor internal target volumes from 4D-PET maximum intensity projections. Med Phys 2011; 38: 5732–7.
10.1118/1.3633896
CAS PubMed Web of Science® Google Scholar
26Callahan J, Kron T, Siva S et al. Geographic miss of lung tumours due to respiratory motion: a comparison of 3D vs 4D PET/CT defined target volumes. Radiat Oncol 2014; 9: 1–8.
10.1186/s13014-014-0291-6
Web of Science® Google Scholar
27Aristophanous M, Yap JT, Killoran JH, Chen AB, Berbeco RI. Four-dimensional positron emission tomography: implications for dose painting of high-uptake regions. Int J Radiat Oncol 2011; 80: 900–8.
10.1016/j.ijrobp.2010.08.028
PubMed Web of Science® Google Scholar
28Lu W, Parikh PJ, Hubenschmidt JP, Bradley JD, Low DA. A comparison between amplitude sorting and phase-angle sorting using external respiratory measurement for 4D CT. Med Phys 2006; 33: 2964–74.
10.1118/1.2219772
CAS PubMed Web of Science® Google Scholar
29Allen AM, Siracuse KM, Hayman JA, Balter JM. Evaluation of the influence of breathing on the movement and modeling of lung tumors. Int J Radiat Oncol 2004; 58: 1251–7.
10.1016/j.ijrobp.2003.09.081
PubMed Web of Science® Google Scholar
30Bowen SR, Nyflot MJ, Herrmann C et al. Imaging and dosimetric errors in 4D PET/CT-guided radiotherapy from patient-specific respiratory patterns: a dynamic motion phantom end-to-end study. Phys Med Biol 2015; 60: 3731.
10.1088/0031-9155/60/9/3731
CAS PubMed Web of Science® Google Scholar
31Karam SD, Horne ZD, Hong RL, McRae D, Duhamel D, Nasr NM. Dose escalation with stereotactic body radiation therapy boost for locally advanced non small cell lung cancer. Radiat Oncol Lond Engl 2013; 8: 179.
10.1186/1748-717X-8-179
PubMed Web of Science® Google Scholar
32Lee E, Zeng J, Miyaoka RS et al. Functional lung avoidance and response-adaptive escalation (FLARE) RT: multimodality plan dosimetry of a precision radiation oncology strategy. Med Phys 2017; 44: 3418–29.
10.1002/mp.12308
CAS PubMed Web of Science® Google Scholar
33 FLARE RT for Patients With Stage IIB-IIIB Non-small Cell Lung Cancer: Personalizing Radiation Therapy Using PET/CT and SPECT/CT Imaging – Full Text View – ClinicalTrials.gov. Available from URL: https://clinicaltrials.gov/ct2/show/NCT02773238. Accessed July 12, 2017.
Google Scholar

Citing Literature

Volume62, Issue1

February 2018

Pages 81-90

Filename	Description
jmiro12693-sup-0001-FigureS1.pdfPDF document, 129.1 KB	Fig. S1. Scatter plots of maximum planned dose versus the quality indices Q_rms (A, B) and V_Q0.95-1.05 (C, D) for varying motion-compensated PET acquistions (A,C) or boost volume definition methods (B,D).
jmiro12693-sup-0002-TableS1.docxWord document, 18.3 KB	Table S1. Tracer uptake values for all segmentation and motion compensation scenarios used in the study.

Impact of tumour motion compensation and delineation methods on FDG PET-based dose painting plan quality for NSCLC radiation therapy

Abstract

Introduction

Methods

Results

Conclusions

Supporting Information

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Impact of tumour motion compensation and delineation methods on FDG PET-based dose painting plan quality for NSCLC radiation therapy

Abstract

Introduction

Methods

Results

Conclusions

Supporting Information

References

Citing Literature

References

Related

Information