Delineation of lung cancer with FDG PET/CT during radiation therapy

J Ganem, S Thureau, I Gardin, R Modzelewski, S Hapdey, P Vera, J Ganem, S Thureau, I Gardin, R Modzelewski, S Hapdey, P Vera

Abstract

Objectives: To propose an easily applicable segmentation method (perPET-RT) for delineation of tumour volume during radiotherapy on interim fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with non-small cell lung cancer (NSCLC).

Material and methods: Sixty-seven patients (51 primary tumours, 60 lymph nodes), from 4 prospective studies, underwent an FDG PET/CT scan during the fifth week of radiation therapy, using different generations of PET/CT. Per-therapeutic PET/CT scans were delineated in consensus by two experienced physicians leading to the gold standard threshold to be applied. The mathematical expression of Thopt, the optimal threshold to be applied as a function of the maximum standard uptake value (SUVmax), was determined. The performance of this method (perPET-RT) was assessed by computing the DICE similarity coefficient (DSC) and was compared with 8 fixed threshold values and 3 adaptive thresholding methods.

Results: Thopt verified the following expression: Thopt = A.ln(1/SUVmax) + B where A and B were 2 constants. A and B were independent from the generation of PET/CT, but depended on the type of lesions (primary lung tumours vs. lymph nodes). PerPET-RT showed good to very good agreement in comparison to the gold standard. The mean and standard deviation of DSC value was 0.81 ± 0.13 for lung lesions and 0.78 ± 0.15 for lymph nodes. PerPET-RT showed a significant better agreement than the other segmentation methods (p < 0.001), except for one of the adaptive thresholding method ADT (p = 0.11).

Conclusion: On the database used, perPET-RT has proven its reliability and accuracy for tumour delineation on per-therapeutic FDG PET/CT using only SUVmax measurement. This method may be used to delineate tumour volume for dose-escalation planning.

Trial registration: NCT01261598 , NCT01261585 , NCT01576796 .

Keywords: Delineation; Lung cancer; PET/CT; Radiation therapy; perPET-RT.

Conflict of interest statement

Ethics approval and consent to participate

All data were extracted from 4 prospective studies (NCT01261598, NCT01261585) (NCT01576796). For all patients, we are a consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient with stage IIIA left lung adenocarcinoma. FDG PET/CT performed before (a.) and during (b) radiation therapy. Pre therapeutic scan (a) show left para-hilar hypermetabolism with SUVmax = 9.6 and MTV = 15.4 cc defined with a threshold value of 41% SUVmax. Per-therapeutic data (b) reveals a decrease in FDG uptake (SUVmax = 4.2) and MTV = 4.8 cc. defined by the experts with a threshold value of 55% of SUVmax
Fig. 2
Fig. 2
Each lesion is represented as a diamond for lung lesions and a square for involved lymph nodes. Thopt, the optimal threshold to be applied for delineation is expressed as a linear regression such as Thopt = A.[ln (1/SUVmax)] + B of the maximum standard uptake value (SUVmax). The expression of Thopt for lung lesions and lymph nodes are presented with their respective coefficient of determination R2
Fig. 3
Fig. 3
Descriptive statistics of DSC for each segmentation methods represented as Box-and-whisker plots for perPET-RT, AOV and fixed thresholding methods for the 111 lesions (a) and for perPET-RT, ADT and COA for the 70 lesions observed on the Biograph Hi-Rez (b)

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