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Experience of PET for target localisation in radiation oncology

Departments of ¹ Radiation Oncology and ² Nuclear Medicine, Klinikum Rechts der Isar, Technical University Munich, Germany

View larger version (97K): [in a new window]   Figure 1. Patient with prostate cancer investigated using an integrated PET/CT. Upper-left: choline-PET/CT image fusion based on three-dimensional (3D) coordinates. Upper-right: choline-PET. The pathological choline uptake could help to visualise the gross tumour mass in the prostate. Below: CT before PET and CT after PET, co-registered using 3D coordinates, documenting the patient's movements during the investigations, which raise concerns about the accuracy of the PET/CT image fusion using integrated PET/CT and data co-registration based on 3D coordinates.

View larger version (62K): [in a new window]   Figure 2. Choline-PET/CT in prostate cancer ((a) choline-PET; (b) three-dimensional-based image fusion after integrated PET/CT). Intensity-modulated radiotherapy and dose painting based on choline-PET. The area with intensive choline-PET (pink) corresponds to gross tumour mass, which may benefit from irradiation with 2.4 Gy/fraction. The remaining prostate (green) could receive 2 Gy/fraction. However, the validity of this hypothesis has to be evaluated in further pathological and PET investigations. The PET studies were performed in co-operation with the Department of Nuclear Medicine, Technical University Munich, Director Prof. M Schwaiger.

View larger version (43K): [in a new window]   Figure 3. (Left to right): methionine (MET)-PET, CT with contrast and T1 MRI with gadolinium (Gd) were co-registered and integrated in the radiation treatment planning of a patient with astrocytoma (WHO stage III), 2 weeks after surgery. The residual tumour (shown by the area of increased MET uptake on the PET scan) is delineated in pink. This region was delineated as the gross tumour volume and was treated with a higher dose (the isodose distribution for the boost volume is shown in green). The yellow arrows show a region of contrast enhancement without MET uptake on PET — this was considered to be due to disturbance of the blood–brain barrier (BBB) as a consequence of surgery and was excluded from the high-dose irradiation area. In this case, MET-PET helped to differentiate between the areas of contrast enhancement due to BBB disturbance after surgery and those due to residual tumour. The PET studies were performed in co-operation with the Department of Nuclear Medicine, Technical University Munich, Director Prof. Dr M Schwaiger, Germany.

View larger version (45K): [in a new window]   Figure 4. Integrated 18F-azomycin arabinoside (FAZA)-PET/CT in a patient with larynx squamous cell carcinoma. The PET/CT image fusion ((a) axial; (b) coronal; (c) intensity-modulated radiotherapy dose painting). The hypoxic area (biological target volume) is treated with 2.4 Gy/fraction; the gross tumour volume, based on radiological and clinical data is treated with 2 Gy/fraction. However, the validity of this hypothesis has to be evaluated in future trials. The FAZA-PET/CT studies were performed in co-operation with the Section of Radiopharmacy, University Tübingen, Prof. Dr H J Machulla, and the Department of Nuclear Medicine, Technical University Munich, Prof. Dr M Schwaiger, Germany. *In this picture the left and right side are changed.