Challenges and opportunities in patient-specific, motion-managed and PET/CT-guided radiation therapy of lung cancer: review and perspective

The increasing interest in combined positron emission tomography (PET) and computed tomography (CT) to guide lung cancer radiation therapy planning has been well documented. Motion management strategies during treatment simulation PET/CT imaging and treatment delivery have been proposed to improve the precision and accuracy of radiotherapy. In light of these research advances, why has translation of motion-managed PET/CT to clinical radiotherapy been slow and infrequent? Solutions to this problem are as complex as they are numerous, driven by large inter-patient variability in tumor motion trajectories across a highly heterogeneous population. Such variation dictates a comprehensive and patient-specific incorporation of motion management strategies into PET/CT-guided radiotherapy rather than a one-size-fits-all tactic. This review summarizes challenges and opportunities for clinical translation of advances in PET/CT-guided radiotherapy, as well as in respiratory motion-managed radiotherapy of lung cancer. These two concepts are then integrated into proposed patient-specific workflows that span classification schemes, PET/CT image formation, treatment planning, and adaptive image-guided radiotherapy delivery techniques.

[1]  Mingqing Chen,et al.  Diaphragm motion quantification in megavoltage cone-beam CT projection images. , 2010, Medical physics.

[2]  Indra J. Das,et al.  Survey: Real-Time Tumor Motion Prediction for Image-Guided Radiation Treatment , 2011, Computing in Science & Engineering.

[3]  Fréderic Duprez,et al.  Adaptive dose painting by numbers for head-and-neck cancer. , 2011, International journal of radiation oncology, biology, physics.

[4]  J Bogaert,et al.  Lymph node staging in non-small-cell lung cancer with FDG-PET scan: a prospective study on 690 lymph node stations from 68 patients. , 1998, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[5]  E. Mittra,et al.  Prospective comparison of combined 18F-FDG and 18F-NaF PET/CT vs. 18F-FDG PET/CT imaging for detection of malignancy , 2012, European Journal of Nuclear Medicine and Molecular Imaging.

[6]  Erika Chin,et al.  Investigation of a novel algorithm for true 4D-VMAT planning with comparison to tracked, gated and static delivery. , 2011, Medical physics.

[7]  C C Ling,et al.  Towards multidimensional radiotherapy (MD-CRT): biological imaging and biological conformality. , 2000, International journal of radiation oncology, biology, physics.

[8]  C. Ling,et al.  Respiration-correlated spiral CT: a method of measuring respiratory-induced anatomic motion for radiation treatment planning. , 2002, Medical physics.

[9]  Radhe Mohan,et al.  Four-dimensional radiotherapy planning for DMLC-based respiratory motion tracking. , 2005, Medical physics.

[10]  Paul Keall,et al.  The clinical implementation of respiratory-gated intensity-modulated radiotherapy. , 2006, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[11]  P. J. Keall,et al.  Potential radiotherapy improvements with respiratory gating , 2009, Australasian Physics & Engineering Sciences in Medicine.

[12]  M. Gould,et al.  The use and misuse of positron emission tomography in lung cancer evaluation. , 2011, Clinics in chest medicine.

[13]  Christian Roux,et al.  A Fuzzy Locally Adaptive Bayesian Segmentation Approach for Volume Determination in PET , 2009, IEEE Transactions on Medical Imaging.

[14]  J. Hendry,et al.  Radiobiology for the Radiologist , 1979, British Journal of Cancer.

[15]  D. Visvikis,et al.  Incorporation of wavelet-based denoising in iterative deconvolution for partial volume correction in whole-body PET imaging , 2009, European Journal of Nuclear Medicine and Molecular Imaging.

[16]  Sasa Mutic,et al.  Impact of FDG-PET on radiation therapy volume delineation in non-small-cell lung cancer. , 2004, International journal of radiation oncology, biology, physics.

[17]  Ursula Nestle,et al.  Practical integration of [18F]-FDG-PET and PET-CT in the planning of radiotherapy for non-small cell lung cancer (NSCLC): the technical basis, ICRU-target volumes, problems, perspectives. , 2006, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[18]  Paul J Keall,et al.  First demonstration of combined kV/MV image-guided real-time dynamic multileaf-collimator target tracking. , 2009, International journal of radiation oncology, biology, physics.

[19]  Sadek Nehmeh,et al.  Does registration of PET and planning CT images decrease interobserver and intraobserver variation in delineating tumor volumes for non-small-cell lung cancer? , 2005, International journal of radiation oncology, biology, physics.

[20]  John N Tsitsiklis,et al.  Optimal margin and edge-enhanced intensity maps in the presence of motion and uncertainty , 2010, Physics in medicine and biology.

[21]  Marcel van Herk,et al.  Short-term and long-term reproducibility of lung tumor position using active breathing control (ABC). , 2006, International journal of radiation oncology, biology, physics.

[22]  H. Vesselle,et al.  Tumor 3′-Deoxy-3′-18F-Fluorothymidine (18F-FLT) Uptake by PET Correlates with Thymidine Kinase 1 Expression: Static and Kinetic Analysis of 18F-FLT PET Studies in Lung Tumors , 2011, The Journal of Nuclear Medicine.

[23]  V. Bettinardi,et al.  Detection and compensation of organ/lesion motion using 4D-PET/CT respiratory gated acquisition techniques. , 2010, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[24]  Gerald J. Kutcher,et al.  The impact of 18F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) lymph node staging on the radiation treatment volumes in patients with non-small cell lung cancer , 2000 .

[25]  Kris Thielemans,et al.  Quiescent period respiratory gating for PET/CT. , 2010, Medical physics.

[26]  Suresh Senan,et al.  Use of maximum intensity projections (MIP) for target volume generation in 4DCT scans for lung cancer. , 2005, International journal of radiation oncology, biology, physics.

[27]  A. Jemal,et al.  Global Cancer Statistics , 2011 .

[28]  A. Jemal,et al.  Global cancer statistics , 2011, CA: a cancer journal for clinicians.

[29]  Lei Xing,et al.  Predicting respiratory tumor motion with multi-dimensional adaptive filters and support vector regression , 2009, Physics in medicine and biology.

[30]  Hiroki Shirato,et al.  Accuracy of tumor motion compensation algorithm from a robotic respiratory tracking system: a simulation study. , 2007, Medical physics.

[31]  Gikas S. Mageras,et al.  Fluoroscopic evaluation of diaphragmatic motion reduction with a respiratory gated radiotherapy system , 2001, Journal of applied clinical medical physics.

[32]  E. Hall,et al.  Radiobiology for the radiologist , 1973 .

[33]  Nagichettiar Satyamurthy,et al.  Molecular Mechanisms of Bone 18F-NaF Deposition , 2010, The Journal of Nuclear Medicine.

[34]  Hiroki Shirato,et al.  Adaptive prediction of respiratory motion for motion compensation radiotherapy , 2007, Physics in medicine and biology.

[35]  C. Rübe,et al.  Comparison of different methods for delineation of 18F-FDG PET-positive tissue for target volume definition in radiotherapy of patients with non-Small cell lung cancer. , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[36]  Radhe Mohan,et al.  Patient training in respiratory-gated radiotherapy. , 2003, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[37]  George Starkschall,et al.  Displacement-based binning of time-dependent computed tomography image data sets. , 2005, Medical physics.

[38]  R Jeraj,et al.  Dual-component model of respiratory motion based on the periodic autoregressive moving average (periodic ARMA) method , 2007, Physics in medicine and biology.

[39]  Michalis Aristophanous,et al.  Clinical utility of 4D FDG-PET/CT scans in radiation treatment planning. , 2012, International journal of radiation oncology, biology, physics.

[40]  Hak Choy,et al.  A phase II comparative study of gross tumor volume definition with or without PET/CT fusion in dosimetric planning for non-small-cell lung cancer (NSCLC): primary analysis of Radiation Therapy Oncology Group (RTOG) 0515. , 2009, International journal of radiation oncology, biology, physics.

[41]  C. Ling,et al.  Effect of respiratory gating on quantifying PET images of lung cancer. , 2002, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[42]  R. Mohan,et al.  Motion adaptive x-ray therapy: a feasibility study , 2001, Physics in medicine and biology.

[43]  Philippe Lambin,et al.  Mature results of an individualized radiation dose prescription study based on normal tissue constraints in stages I to III non-small-cell lung cancer. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[44]  L. Wiens,et al.  Validation of FLT uptake as a measure of thymidine kinase-1 activity in A549 carcinoma cells. , 2002, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[45]  Harry Keller,et al.  Application of the spirometer in respiratory gated radiotherapy. , 2003, Medical physics.

[46]  Klaus Schilling,et al.  Tumor tracking and motion compensation with an adaptive tumor tracking system (ATTS): System description and prototype testing. , 2008, Medical physics.

[47]  Michalis Aristophanous,et al.  Four-dimensional positron emission tomography: implications for dose painting of high-uptake regions. , 2011, International journal of radiation oncology, biology, physics.

[48]  Paul E Kinahan,et al.  The impact of respiratory motion on tumor quantification and delineation in static PET/CT imaging , 2009, Physics in medicine and biology.

[49]  Tomio Inoue,et al.  Deep-Inspiration Breath-Hold PET/CT of Lung Cancer: Maximum Standardized Uptake Value Analysis of 108 Patients , 2008, Journal of Nuclear Medicine.

[50]  M. Schwaiger,et al.  Differentiation of tumour and inflammation: characterisation of [methyl-3H]methionine (MET) and O-(2-[18F]fluoroethyl)-L-tyrosine (FET) uptake in human tumour and inflammatory cells , 2006, European Journal of Nuclear Medicine and Molecular Imaging.

[51]  Geoffrey G. Zhang,et al.  Four-dimensional computed tomography scan analysis of tumor and organ motion at varying levels of abdominal compression during stereotactic treatment of lung and liver. , 2008, International journal of radiation oncology, biology, physics.

[52]  Sasa Mutic,et al.  18F-FDG PET definition of gross tumor volume for radiotherapy of non-small cell lung cancer: is a single standardized uptake value threshold approach appropriate? , 2006, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[53]  A. Pevsner,et al.  The CT motion quantitation of lung lesions and its impact on PET-measured SUVs. , 2004, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[54]  J. Bradley,et al.  Clinical perspectives on dose escalation for non-small-cell lung cancer. , 2010, Clinical lung cancer.

[55]  Lei Xing,et al.  Automated contour mapping with a regional deformable model. , 2008, International journal of radiation oncology, biology, physics.

[56]  M. Graham,et al.  Can FDG-PET reduce the need for mediastinoscopy in potentially resectable nonsmall cell lung cancer? , 2002, The Annals of thoracic surgery.

[57]  Klaus Schilling,et al.  Tumor tracking and motion compensation with an adaptive tumor tracking system (ATTS): system description and prototype testing. , 2008, Medical physics.

[58]  Søren M Bentzen,et al.  Theragnostic imaging for radiation oncology: dose-painting by numbers. , 2005, The Lancet. Oncology.

[59]  V. Grégoire,et al.  Gradient-based delineation of the primary GTV on FDG-PET in non-small cell lung cancer: a comparison with threshold-based approaches, CT and surgical specimens. , 2011, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[60]  Ellen Yorke,et al.  18F-FDG PET/CT for Image-Guided and Intensity-Modulated Radiotherapy* , 2009, Journal of Nuclear Medicine.

[61]  Dimitris Visvikis,et al.  Accurate automatic delineation of heterogeneous functional volumes in positron emission tomography for oncology applications. , 2010, International journal of radiation oncology, biology, physics.

[62]  R. Cerfolio,et al.  Predictors and treatment of persistent air leaks. , 2002, The Annals of thoracic surgery.

[63]  C. Ling,et al.  Effect of respiratory gating on reducing lung motion artifacts in PET imaging of lung cancer. , 2002, Medical physics.

[64]  J. Wong,et al.  The use of active breathing control (ABC) to reduce margin for breathing motion. , 1999, International journal of radiation oncology, biology, physics.

[65]  Geoffrey G. Zhang,et al.  Dose mapping: Validation in 4D dosimetry with measurements and application in radiotherapy follow-up evaluation , 2008, Comput. Methods Programs Biomed..

[66]  J C Stroom,et al.  Inclusion of geometrical uncertainties in radiotherapy treatment planning by means of coverage probability. , 1999, International journal of radiation oncology, biology, physics.

[67]  M. V. van Herk,et al.  Precise and real-time measurement of 3D tumor motion in lung due to breathing and heartbeat, measured during radiotherapy. , 2002, International journal of radiation oncology, biology, physics.

[68]  Dirk De Ruysscher,et al.  PET scans in radiotherapy planning of lung cancer. , 2010, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[69]  Steve B. Jiang,et al.  Effects of motion on the total dose distribution. , 2004, Seminars in radiation oncology.

[70]  L. Królicki,et al.  Bone metastases diagnosis possibilities in studies with the use of 18F-NaF and 18F-FDG. , 2011, Nuclear medicine review. Central & Eastern Europe.

[71]  Matthias Guckenberger,et al.  Positioning accuracy of cone-beam computed tomography in combination with a HexaPOD robot treatment table. , 2007, International journal of radiation oncology, biology, physics.

[72]  Paul E Kinahan,et al.  Respiratory motion correction for quantitative PET/CT using all detected events with internal-external motion correlation. , 2011, Medical physics.

[73]  Robert Jeraj,et al.  PET scans in radiotherapy planning of lung cancer. , 2012, Lung cancer.

[74]  J. Eary,et al.  [18F]FMISO and [18F]FDG PET imaging in soft tissue sarcomas: correlation of hypoxia, metabolism and VEGF expression , 2003, European Journal of Nuclear Medicine and Molecular Imaging.

[75]  C B Caldwell,et al.  Observer variation in contouring gross tumor volume in patients with poorly defined non-small-cell lung tumors on CT: the impact of 18FDG-hybrid PET fusion. , 2001, International journal of radiation oncology, biology, physics.

[76]  Dimitris Visvikis,et al.  Reproducibility of 18F-FDG and 3′-Deoxy-3′-18F-Fluorothymidine PET Tumor Volume Measurements , 2010, The Journal of Nuclear Medicine.

[77]  Steve B. Jiang,et al.  Residual motion of lung tumours in gated radiotherapy with external respiratory surrogates , 2005, Physics in medicine and biology.

[78]  A. Ahnesjö,et al.  Portal dose image verification: the collapsed cone superposition method applied with different electronic portal imaging devices , 2006, Physics in medicine and biology.

[79]  Suresh Senan,et al.  Critical review of PET-CT for radiotherapy planning in lung cancer. , 2005, Critical reviews in oncology/hematology.

[80]  Carole Lartizien,et al.  A lesion detection observer study comparing 2-dimensional versus fully 3-dimensional whole-body PET imaging protocols. , 2004, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[81]  P. Jarritt,et al.  (18)F-FDG PET-CT simulation for non-small-cell lung cancer: effect in patients already staged by PET-CT. , 2010, International journal of radiation oncology, biology, physics.

[82]  Joao Seco,et al.  Motion management with phase-adapted 4D-optimization , 2010, Physics in medicine and biology.

[83]  P. Kneschaurek,et al.  Evaluation of the SUV values calculation and 4D PET integration in the radiotherapy treatment planning system. , 2011, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[84]  Margrit Betke,et al.  The correlation between internal and external markers for abdominal tumors: implications for respiratory gating. , 2003, International journal of radiation oncology, biology, physics.

[85]  Thomas Bortfeld,et al.  Reducing the sensitivity of IMPT treatment plans to setup errors and range uncertainties via probabilistic treatment planning. , 2008, Medical physics.

[86]  Habib Zaidi,et al.  PET-guided delineation of radiation therapy treatment volumes: a survey of image segmentation techniques , 2010, European Journal of Nuclear Medicine and Molecular Imaging.

[87]  C C Ling,et al.  The deep inspiration breath-hold technique in the treatment of inoperable non-small-cell lung cancer. , 2000, International journal of radiation oncology, biology, physics.

[88]  Herbert Cattell,et al.  Geometric accuracy of a real-time target tracking system with dynamic multileaf collimator tracking system. , 2006, International journal of radiation oncology, biology, physics.

[89]  Andrea Schaefer,et al.  A contrast-oriented algorithm for FDG-PET-based delineation of tumour volumes for the radiotherapy of lung cancer: derivation from phantom measurements and validation in patient data , 2008, European Journal of Nuclear Medicine and Molecular Imaging.

[90]  R Mohan,et al.  Determining parameters for respiration-gated radiotherapy. , 2001, Medical physics.

[91]  Heiko Schöder,et al.  Deep-Inspiration Breath-Hold PET/CT: Clinical Findings with a New Technique for Detection and Characterization of Thoracic Lesions , 2007, Journal of Nuclear Medicine.

[92]  E. Yorke,et al.  Deep inspiration breath hold and respiratory gating strategies for reducing organ motion in radiation treatment. , 2004, Seminars in radiation oncology.

[93]  Gikas S. Mageras,et al.  Phase I dose escalation study using the deep inspiration breath hold technique to safely increase dose to 81 Gy in the treatment of inoperable non-small cell lung cancer , 2000 .

[94]  Yuji Nakamoto,et al.  Accuracy of image fusion of normal upper abdominal organs visualized with PET/CT , 2003, European Journal of Nuclear Medicine and Molecular Imaging.

[95]  Steve B. Jiang,et al.  The management of respiratory motion in radiation oncology report of AAPM Task Group 76. , 2006, Medical physics.

[96]  Alexander Schlaefer,et al.  Correlation between external and internal respiratory motion: a validation study , 2011, International Journal of Computer Assisted Radiology and Surgery.