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PET–CT for radiotherapy treatment planning and response monitoring in solid tumors

Nature Reviews Clinical Oncology volume 8, pages 233–242 (2011)Cite this article

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Abstract

PET imaging has evolved as an indispensible tool for staging in oncology. Multiple quantitative measurements can be performed, enabling the effects of treatment to be monitored before changes are detectable with the use of conventional imaging modalities. PET tracers are available to visualize and quantify the most important mechanisms of resistance to radiotherapy and chemoradiotherapy. Reproducibility of these tracers depends on the particular tracer and the underlying biology of the process that is being investigated. PET enables clinicians to select patients for intensified treatment on the basis of resistance mechanisms taking place at the molecular level. From translational studies and randomized trials, it has become clear that appropriate patient selection can prevent unnecessary rejection of various treatment options through the observation of individual patients rather than only looking at the results of a large study population.

Key Points

  • PET tracers are available for visualization and quantification of the most important mechanisms involved in resistance to radiotherapy and chemoradiotherapy

  • PET combined with [18F]-fluorodeoxyglucose ([18F]-FDG) as a metabolic marker is more powerful than for staging alone, and it can be used for treatment selection based on quantifying the intensity of [18F]-FDG uptake

  • Monitoring early response when using highly effective but more-toxic regimens, such as concomitant chemoradiotherapy, probably necessitates earlier rescanning than when using chemotherapy or radiotherapy alone

  • The predictive value of [18F]-fluoromisonidazole-PET is indicated by the fact that, on the basis of using this tracer, the number of recurrent tumors can be reduced by specifically targeting hypoxic tumor cells

  • The role for [18F]-fluorothymidine-PET imaging in oncology is in the identification of resistant tumor subvolumes and the possibility to monitor early treatment response rather than in tumor staging

  • If patient selection for specific trials is not improved, treatment modalities might be disregarded if no benefit is observed in the study population as a whole

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Figure 1: Squamous-cell carcinoma of the lung with a pathological lymph node.
Figure 2: Squamous-cell carcinoma of the supraglottic larynx.

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L. Barclay, freelance writer and reviewer, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Department of Radiation Oncology, Radboud University Nijmegen Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands

    Johan Bussink & Johannes H. A. M. Kaanders

  2. Department of Medical Oncology, Radboud University Nijmegen Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands

    Winette T. A. van der Graaf

  3. Department of Nuclear Medicine, Radboud University Nijmegen Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands

    Wim J. G. Oyen

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Bussink, J., Kaanders, J., van der Graaf, W. et al. PET–CT for radiotherapy treatment planning and response monitoring in solid tumors. Nat Rev Clin Oncol 8, 233–242 (2011). https://doi.org/10.1038/nrclinonc.2010.218

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