Impact of hybrid FDG-PET/CT on gross tumor volume definition of cervical esophageal cancer: reducing interobserver variation
Impact of hybrid FDG-PET/CT on gross tumor volume definition of cervical esophageal cancer: reducing interobserver variation
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DOI：
10.1093/jrr/rrz004
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发表时间：
2019-05-01
影响因子：
2
通讯作者：
Oya, Natsuo
中科院分区：
文献类型：
--
作者：
Toya, Ryo;Matsuyama, Tomohiko;Oya, Natsuo
调强放射治疗正越来越多地应用于颈段食管癌(CEC)的治疗；然而，准确地描绘大体肿瘤体积(GTV)是其成功治疗的关键。使用计算机断层扫描(CT)图像来确定GTV会产生很大程度的观察者间差异。在这项研究中，我们评估了与单独使用CT图像相比，使用[F-18]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描(FDG-PET)/CT融合图像是否减少了观察者间的差异，以确定CEC患者的GTV。对10例CEC患者进行FDG-PET/CT扫描，成像位置在带枕头的平板上。5位放射肿瘤学家使用常规临床数据独立定义了原发肿瘤的GTV；他们根据CT图像勾画GTV(CT)，然后基于FDG-PET/CT融合图像(GTV(PET/CT))勾画GTV。为了确定几何观测值的变化，我们计算了GTV的交集与其并集的比率的一致性指数(CI)。观察者间CI比较采用Wilcoxon符号秩检验法。GTV(CT)和GTV(PET/CT)的平均(+/-SD)Cis分别为0.39±-0.15和0.58+/-0.10(P=0.005)。我们的结果表明，FDG-PET/CT图像在确定CEC患者的GTV时减少了观察者间的差异。FDG-PET/CT可提高CEC患者放射学所测GTV的一致性。
Intensity-modulated radiation therapy is being increasingly used to treat cervical esophageal cancer (CEC); however, delineating the gross tumor volume (GTV) accurately is essential for its successful treatment. The use of computed tomography (CT) images to determine the GTV produces a large degree of interobserver variation. In this study, we evaluated whether the use of [F-18]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/CT fused images reduced interobserver variation, compared with CT images alone, to determine the GTV in patients with CEC. FDG-PET/CT scans were obtained for 10 patients with CEC, imaged positioned on a flat tabletop with a pillow. Five radiation oncologists independently defined the GTV for the primary tumors using routine clinical data; they contoured the GTV based on CT images (GTV(CT)), followed by contouring based on FDG-PET/CT fused images (GTV(PET/CT)). To determine the geometric observer variation, we calculated the conformality index (CI) from the ratio of the intersection of the GTVs to their union. The interobserver CI was compared using Wilcoxon's signed rank test. The mean (+/- SD) interobserver CIs of GTV(CT) and GTV(PET/CT) were 0.39 +/- 0.15 and 0.58 +/- 0.10, respectively (P = 0.005). Our results suggested that FDG-PET/CT images reduced interobserver variation when determining the GTV in patients with CEC. FDG-PET/CT may increase the consistency of the radiographically determined GTV in patients with CEC.