Focal dose escalation using FDG-PET-guided intensity-modulated radiation therapy boost for postoperative local recurrent rectal cancer: A planning study with comparison of DVH and NTCP

Keiichi Jingu, Hisanori Ariga, Tomohiro Kaneta, Yoshihiro Takai, Ken Takeda, Lindel Katja, Kakutaro Narazaki, Takahiro Metoki, Keisuke Fujimoto, Rei Umezawa, Yoshihiro Ogawa, Kenji Nemoto, Masashi Koto, Masatoshi Mitsuya, Naruhiro Matsufuji, Shoki Takahashi, Shogo Yamada

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22 Citations (Scopus)

Abstract

Background: To evaluate the safety of focal dose escalation to regions with standardized uptake value (SUV) >2.0 using intensity-modulated radiation therapy (IMRT) by comparison of radiotherapy plans using dose-volume histograms (DVHs) and normal tissue complication probability (NTCP) for postoperative local recurrent rectal cancer. Methods: First, we performed conventional radiotherapy with 40 Gy/20 fr. (CRT 40 Gy) for 12 patients with postoperative local recurrent rectal cancer, and then we performed FDG-PET/CT radiotherapy planning for those patients. We defined the regions with SUV > 2.0 as biological target volume (BTV) and made three boost plans for each patient: 1) CRT boost plan, 2) IMRT without dose-painting boost plan, and 3) IMRT with dose-painting boost plan. The total boost dose was 20 Gy. In IMRT with dose-painting boost plan, we increased the dose for BTV+5 mm by 30% of the prescribed dose. We added CRT boost plan to CRT 40 Gy (summed plan 1), IMRT without dose-painting boost plan to CRT 40 Gy (summed plan 2) and IMRT with dose-painting boost plan to CRT 40 Gy (summed plan 3), and we compared those plans using DVHs and NTCP.Results: Dmeanof PTV-PET and that of PTV-CT were 26.5 Gy and 21.3 Gy, respectively. V50of small bowel PRV in summed plan 1 was significantly higher than those in other plans ((summed plan 1 vs. summed plan 2 vs. summed plan 3: 47.11 ± 45.33 cm3vs. 40.63 ± 39.13 cm3 vs. 41.25 ± 39.96 cm3(p < 0.01, respectively)). There were no significant differences in V30, V40, V60, Dmean or NTCP of small bowel PRV.Conclusions: FDG-PET-guided IMRT can facilitate focal dose-escalation to regions with SUV above 2.0 for postoperative local recurrent rectal cancer.

Original languageEnglish
Article number127
JournalBMC Cancer
Volume10
DOIs
Publication statusPublished - 2010 Apr 7

ASJC Scopus subject areas

  • Genetics
  • Oncology
  • Cancer Research

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