Use of PET/CT for patient selection and radiation therapy target volume definition in patients with non-small-cell lung cancer

摘要

PET scanning is having an increasing impact on the treatment of non-small-cell lung cancer with radiation therapy (RT) and chemoRT. It has a powerful impact on staging, often revealing evidence of more advanced, frequently incurable, disease in patients who would otherwise be considered suitable for treatment with potentially curative definitive RT. Approximately a third of curative RT candidates are found to be unsuitable for this often highly toxic form of treatment after PET, thereby ensuring that this intensive treatment is only given to those patients who might benefit from it. If a patient remains suitable for treatment with RT after PET staging, PET can play a further critical role in the targeting of the RT. Without the use of PET in this way, a quarter of patients or more would experience geographic misses, in which some tumor regions would be either underdosed or excluded entirely from treatment, thereby compromising the chances of a successful outcome. There is emerging evidence that the overall results of treatment with RT can be improved by the appropriate use of PET in non-small-cell lung cancer.