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aydınlar - Radiation Oncology BioMed...

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Bio Med Central Page 1 of 7 (page number not for citation purposes) Radiation Oncology Open Access Research Comparison of CT and integrated PET-CT based radiation therapy planning in patients with malignant pleural mesothelioma Berrin Pehlivan* †1 , Erkan Topkan †1 , Cem Onal †1 , Gul Nihal Nursal †2 , Oznur Yuksel †1 , Yemliha Dolek †1 , Melek Nur Yavuz †1 and Ali Aydin Yavuz †1 Address: 1 Department of Radiation Oncology, Baskent University Medical Faculty, Adana Medical and Research Center, Kisla Campus, Adana, Turkey and 2 Department of Nuclear Medicine, Baskent University Medical Faculty, Adana Medical and Research Center, Kisla Campus, Adana, Turkey Email: Berrin Pehlivan* - [email protected]; Erkan Topkan - [email protected]; Cem Onal - [email protected]; Gul Nihal Nursal - [email protected]; Oznur Yuksel - [email protected]; Yemliha Dolek - [email protected]; Melek Nur Yavuz - [email protected]; Ali Aydin Yavuz - [email protected] * Corresponding author †Equal contributors Abstract Background: When combined with adequate tumoricidal doses, accurate target volume delineation remains to be the one of the most important predictive factors for radiotherapy (RT) success in locally advanced or medically inoperable malignant pleural mesothelioma (MPM) patients. Recently, 18-fluorodeoxyglucose positron emission tomography (PET) has demonstrated significant improvements in diagnosis and accurate staging of MPM. However, role of additional PET data has not been studied in RT planning (RTP) of patients with inoperable MPM or in those who refuse surgery. Therefore, we planned to compare CT with co-registered PET-CT as the basis for delineating target volumes in these patients group. Methods: Retrospectively, the CT and co-registered PET-CT data of 13 patients with histologically proven MPM were utilized to delineate target volumes separately. For each patient, target volumes (gross tumor volume [GTV], clinical target volume [CTV], and planning target volume [PTV]) were defined using the CT and PET-CT fusion data sets. The PTV was measured in two ways: PTV1 was CTV plus a 1-cm margin, and PTV2 was GTV plus a 1-cm margin. We analyzed differences in target volumes. Results: In 12 of 13 patients, compared to CT-based delineation, PET-CT-based delineation resulted in a statistically significant decrease in the mean GTV, CTV, PTV1, and PTV2. In these 12 patients, mean GTV decreased by 47.1% ± 28.4%, mean CTV decreased by 38.7% ± 24.7%, mean PTV1 decreased by 31.1% ± 23.1%, and mean PTV2 decreased by 40.0% ± 24.0%. In 4 of 13 patients, hilar lymph nodes were identified by PET-CT that was not identified by CT alone, changing the nodal status of tumor staging in those patients. Conclusion: This study demonstrated the usefulness of PET-CT-based target volume delineation in patients with MPM. Co-registration of PET and CT information reduces the likelihood of geographic misses, and additionally, significant reductions observed in target volumes may
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