• Int. J. Radiat. Oncol. Biol. Phys. · Aug 2014

    Randomized Controlled Trial

    Role of FDG-PET in the implementation of involved-node radiation therapy for Hodgkin lymphoma patients.

    • Théodore Girinsky, Anne Aupérin, Vincent Ribrag, Manel Elleuch, Christophe Fermé, Guillaume Bonniaud, Claude Ruelle, Jean-Louis Alberini, Aljosa Celebic, and Véronique Edeline.
    • Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France.
    • Int. J. Radiat. Oncol. Biol. Phys. 2014 Aug 1; 89 (5): 1047-1052.

    PurposeThis study examines the role of (18)F-labeled fluorodeoxyglucose positron emission tomography (FDG-PET) in the implementation of involved-node radiation therapy (INRT) in patients treated for clinical stages (CS) I/II supradiaphragmatic Hodgkin lymphoma (HL).Methods And MaterialPatients with untreated CS I/II HL enrolled in the randomized EORTC/LYSA/FIL Intergroup H10 trial and participating in a real-time prospective quality assurance program were prospectively included in this study. Data were electronically obtained from 18 French cancer centers. All patients underwent APET-computed tomography (PET-CT) and a post-chemotherapy planning CT scanning. The pre-chemotherapy gross tumor volume (GTV) and the postchemotherapy clinical target volume (CTV) were first delineated on CT only by the radiation oncologist. The planning PET was then co-registered, and the delineated volumes were jointly analyzed by the radiation oncologist and the nuclear medicine physician. Lymph nodes undetected on CT but FDG-avid were recorded, and the previously determined GTV and CTV were modified according to FDG-PET results.ResultsFrom March 2007 to February 2010, 135 patients were included in the study. PET-CT identified at least 1 additional FDG-avid lymph node in 95 of 135 patients (70.4%; 95% confidence interval [CI]: 61.9%-77.9%) and 1 additional lymph node area in 55 of 135 patients (40.7%; 95% CI: 32.4%-49.5%). The mean increases in the GTV and CTV were 8.8% and 7.1%, respectively. The systematic addition of PET to CT led to a CTV increase in 60% of the patients.ConclusionsPre-chemotherapy FDG-PET leads to significantly better INRT delineation without necessarily increasing radiation volumes.Copyright © 2014 Elsevier Inc. All rights reserved.

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