Comparison of standardized uptake value-based positron emission tomography and computed tomography target volumes in esophageal cancer patients undergoing radiotherapy

Faisal S. Vali, Suneel Nagda*, William Hall, James Sinacore, Mingcheng Gao, Steven H. Lee, Robert Hong, Margaret Shoup, Bahman Emami

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Purpose: To study various standardized uptake value (SUV)-based approaches to ascertain the best strategy for delineating metabolic tumor volumes (MTV). Methods and Materials: Twenty-two consecutive previously treated esophageal cancer patients with positron emission tomography (PET) imaging and computed tomography (CT)-based radiotherapy plans were studied. At the level of the tumor epicenter, MTVs were delineated at 11 different thresholds: SUV ≥2, ≥2.5, ≥3, ≥3.5 (SUVn); ≥40%, ≥45%, and ≥50% of the maximum (SUVn%); and mean liver SUV + 1, 2, 3, and 4 standard deviations (SUVLnσ). The volume ratio and conformality index were determined between MTVs, and the corresponding CT/endoscopic ultrasound-based gross tumor volume (GTV) at the epicenter. Means were analyzed by one-way analysis of variance for repeated measures and further compared using a paired t test for repeated measures. Results: The mean conformality indices ranged from 0.33 to 0.48, being significantly (p < 0.05) closest to 1 at SUV 2.5 (0.47 ± 0.03) and SUVL4σ (0.48 ± 0.03). The mean volume ratios ranged from 0.39 to 2.82, being significantly closest to 1 at SUV2.5 (1.18 ± 0.36) and SUV L4σ (1.09 ± 0.15). The mean value of the SUVs calculated using the SUVL4σ approach was 2.4. Conclusions: Regardless of the SUV thresholding method used (i.e., absolute or relative to liver mean), a threshold of approximately 2.5 yields the highest conformality index and best approximates the CT-based GTV at the epicenter. These findings may ultimately aid radiation oncologists in the delineation of the entire GTV in esophageal cancer patients.

Original languageEnglish (US)
Pages (from-to)1057-1063
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume78
Issue number4
DOIs
StatePublished - Nov 4 2010

Keywords

  • Esophageal cancer
  • Positron emission tomography
  • Radiotherapy planning
  • Standardized uptake value
  • Target volume

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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