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Variations in target volume definition and dose to normal tissue using anatomic versus biological imaging ((18) F-FDG-PET) in the treatment of bone metastases: results from a 3-arm randomized phase II trial


Berwouts, Dieter; De Wolf, Katrien; De Neve, Wilfried; Olteanu, Luiza Am; Lambert, Bieke; Speleers, Bruno; Goethals, Ingeborg; Madani, Indira; Ost, Piet (2017). Variations in target volume definition and dose to normal tissue using anatomic versus biological imaging ((18) F-FDG-PET) in the treatment of bone metastases: results from a 3-arm randomized phase II trial. Journal of Medical Imaging and Radiation Oncology, 61(1):124-132.

Abstract

INTRODUCTION To report the impact on target volume delineation and dose to normal tissue using anatomic versus biological imaging ((18) F-FDG-PET) for bone metastases. METHODS Patients with uncomplicated painful bone metastases were randomized (1:1:1) and blinded to receive either 8 Gy in a single fraction with conventionally planned radiotherapy (ConvRT-8 Gy) or 8 Gy in a single fraction with dose-painting-by-numbers (DPBN) dose range between 6 and 10 Gy) (DPBN-8 Gy) or 16 Gy in a single fraction with DPBN (dose range between 14 and 18 Gy) (DPBN-16 Gy). The primary endpoint was overall pain response at 1 month. Volumes of the gross tumour volume (GTV) - both biological (GTVPET ) and anatomical (GTVCT ) -, planning target volume (PTV), dose to the normal tissue and maximum standardized-uptake values (SUVMAX ) were analysed (secondary endpoint). RESULTS Sixty-three percent of the GTVCT volume did not show (18) F-FDG-uptake. On average, 20% of the GTVPET volume was outside GTVCT . The volume of normal tissue receiving 4 Gy, 6 Gy and 8 Gy was at least 3×, 6× and 13× smaller in DPBN-8 Gy compared to ConvRT-8 Gy and DPBN-16 Gy (P < 0.05). CONCLUSION Positron emitting tomography-information potentially changes the target volume for bone metastases. DPBN between 6 and 10 Gy significantly decreases dose to the normal tissue compared to conventional radiotherapy.

Abstract

INTRODUCTION To report the impact on target volume delineation and dose to normal tissue using anatomic versus biological imaging ((18) F-FDG-PET) for bone metastases. METHODS Patients with uncomplicated painful bone metastases were randomized (1:1:1) and blinded to receive either 8 Gy in a single fraction with conventionally planned radiotherapy (ConvRT-8 Gy) or 8 Gy in a single fraction with dose-painting-by-numbers (DPBN) dose range between 6 and 10 Gy) (DPBN-8 Gy) or 16 Gy in a single fraction with DPBN (dose range between 14 and 18 Gy) (DPBN-16 Gy). The primary endpoint was overall pain response at 1 month. Volumes of the gross tumour volume (GTV) - both biological (GTVPET ) and anatomical (GTVCT ) -, planning target volume (PTV), dose to the normal tissue and maximum standardized-uptake values (SUVMAX ) were analysed (secondary endpoint). RESULTS Sixty-three percent of the GTVCT volume did not show (18) F-FDG-uptake. On average, 20% of the GTVPET volume was outside GTVCT . The volume of normal tissue receiving 4 Gy, 6 Gy and 8 Gy was at least 3×, 6× and 13× smaller in DPBN-8 Gy compared to ConvRT-8 Gy and DPBN-16 Gy (P < 0.05). CONCLUSION Positron emitting tomography-information potentially changes the target volume for bone metastases. DPBN between 6 and 10 Gy significantly decreases dose to the normal tissue compared to conventional radiotherapy.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Radiation Oncology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2017
Deposited On:12 Jan 2017 10:48
Last Modified:07 Feb 2017 02:03
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1754-9477
Publisher DOI:https://doi.org/10.1111/1754-9485.12507
PubMed ID:27527354

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