A methodology for incorporating functional bone marrow sparing in IMRT planning for pelvic radiation therapy

Sarah M. McGuire, Yusuf Menda, Laura L. Boles Ponto, Brandie Gross, Malik Juweid, John E. Bayouth

Research output: Contribution to journalArticle

32 Scopus citations


Background and purpose: The purpose of this study was to design a radiation therapy treatment planning approach that would spare hematopoietically active bone marrow using [ 18F]FLT PET imaging. Materials and methods: We have developed an IMRT planning methodology to incorporate functional PET imaging using [ 18F]FLT scans. Plans were generated for two simulated cervical cancer patients, where pelvic active bone marrow regions were incorporated as avoidance regions based on the ranges: SUV4 ≥ 4; 4 > SUV3 ≥ 3; and 3 > SUV2 ≥ 2. Dose objectives were set to reduce bone marrow volume that received 10 (V 10) and 20 (V 20) Gy. Results: Active bone marrow regions identified by [ 18F]FLT with an SUV ≥ 2, SUV ≥ 3, and SUV ≥ 4 represented an average of 43.0%, 15.3%, and 5.8%, respectively of the total osseous pelvis for the two cases studied. Improved dose-volume histograms for all identified bone marrow SUV volumes and decreases in V 10, and V 20 were achieved without clinically significant changes to PTV or OAR doses. Conclusions: Incorporation of [ 18F]FLT PET in IMRT planning provides a methodology to reduce radiation dose to active bone marrow without compromising PTV or OAR dose objectives in pelvic malignancies.

Original languageEnglish (US)
Pages (from-to)49-54
Number of pages6
JournalRadiotherapy and Oncology
Issue number1
Publication statusPublished - Apr 1 2011



  • [ F]FLT PET
  • Bone marrow
  • Cervical cancer
  • IMRT

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology

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