A phase II comparative study of gross tumor volume definition with or without PET/CT fusion in dosimetric planning for non-small-cell lung cancer (NSCLC): Primary analysis of Radiation Therapy Oncology Group (RTOG) 0515

Jeffrey Bradley, Kyounghwa Bae, Noah Choi, Ken Forster, Barry A. Siegel, Jacqueline Brunetti, James Purdy, Sergio Faria, Toni Vu, Wade Thorstad, Hak Choy

Research output: Contribution to journalArticle

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Abstract

Background: Radiation Therapy Oncology Group (RTOG) 0515 is a Phase II prospective trial designed to quantify the impact of positron emission tomography (PET)/computed tomography (CT) compared with CT alone on radiation treatment plans (RTPs) and to determine the rate of elective nodal failure for PET/CT-derived volumes. Methods: Each enrolled patient underwent definitive radiation therapy for non-small-cell lung cancer (≥60 Gy) and had two RTP datasets generated: gross tumor volume (GTV) derived with CT alone and with PET/CT. Patients received treatment using the PET/CT-derived plan. The primary end point, the impact of PET/CT fusion on treatment plans was measured by differences of the following variables for each patient: GTV, number of involved nodes, nodal station, mean lung dose (MLD), volume of lung exceeding 20 Gy (V20), and mean esophageal dose (MED). Regional failure rate was a secondary end point. The nonparametric Wilcoxon matched-pairs signed-ranks test was used with Bonferroni adjustment for an overall significance level of 0.05. Results: RTOG 0515 accrued 52 patients, 47 of whom are evaluable. The follow-up time for all patients is 12.9 months (2.7-22.2). Tumor staging was as follows: II = 6%; IIIA = 40%; and IIIB = 54%. The GTV was statistically significantly smaller for PET/CT-derived volumes (98.7 vs. 86.2 mL; p < 0.0001). MLDs for PET/CT plans were slightly lower (19 vs. 17.8 Gy; p = 0.06). There was no significant difference in the number of involved nodes (2.1 vs. 2.4), V20 (32% vs. 30.8%), or MED (28.7 vs. 27.1 Gy). Nodal contours were altered by PET/CT for 51% of patients. One patient (2%) has developed an elective nodal failure. Conclusions: PET/CT-derived tumor volumes were smaller than those derived by CT alone. PET/CT changed nodal GTV contours in 51% of patients. The elective nodal failure rate for GTVs derived by PET/CT is quite low, supporting the RTOG standard of limiting the target volume to the primary tumor and involved nodes.

Original languageEnglish (US)
Pages (from-to)435-441
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume82
Issue number1
DOIs
StatePublished - Jan 1 2012

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Radiation Oncology
Tumor Burden
Non-Small Cell Lung Carcinoma
lungs
planning
radiation therapy
positrons
Radiotherapy
tumors
tomography
fusion
cancer
Tomography
Positron Emission Tomography Computed Tomography
Radiation
Background Radiation
Lung
Neoplasm Staging
Therapeutics
dosage

Keywords

  • FDG-PET
  • Lung cancer
  • Mediastinal nodal staging
  • mediastinum

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

A phase II comparative study of gross tumor volume definition with or without PET/CT fusion in dosimetric planning for non-small-cell lung cancer (NSCLC) : Primary analysis of Radiation Therapy Oncology Group (RTOG) 0515. / Bradley, Jeffrey; Bae, Kyounghwa; Choi, Noah; Forster, Ken; Siegel, Barry A.; Brunetti, Jacqueline; Purdy, James; Faria, Sergio; Vu, Toni; Thorstad, Wade; Choy, Hak.

In: International Journal of Radiation Oncology Biology Physics, Vol. 82, No. 1, 01.01.2012, p. 435-441.

Research output: Contribution to journalArticle

Bradley, Jeffrey ; Bae, Kyounghwa ; Choi, Noah ; Forster, Ken ; Siegel, Barry A. ; Brunetti, Jacqueline ; Purdy, James ; Faria, Sergio ; Vu, Toni ; Thorstad, Wade ; Choy, Hak. / A phase II comparative study of gross tumor volume definition with or without PET/CT fusion in dosimetric planning for non-small-cell lung cancer (NSCLC) : Primary analysis of Radiation Therapy Oncology Group (RTOG) 0515. In: International Journal of Radiation Oncology Biology Physics. 2012 ; Vol. 82, No. 1. pp. 435-441.
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abstract = "Background: Radiation Therapy Oncology Group (RTOG) 0515 is a Phase II prospective trial designed to quantify the impact of positron emission tomography (PET)/computed tomography (CT) compared with CT alone on radiation treatment plans (RTPs) and to determine the rate of elective nodal failure for PET/CT-derived volumes. Methods: Each enrolled patient underwent definitive radiation therapy for non-small-cell lung cancer (≥60 Gy) and had two RTP datasets generated: gross tumor volume (GTV) derived with CT alone and with PET/CT. Patients received treatment using the PET/CT-derived plan. The primary end point, the impact of PET/CT fusion on treatment plans was measured by differences of the following variables for each patient: GTV, number of involved nodes, nodal station, mean lung dose (MLD), volume of lung exceeding 20 Gy (V20), and mean esophageal dose (MED). Regional failure rate was a secondary end point. The nonparametric Wilcoxon matched-pairs signed-ranks test was used with Bonferroni adjustment for an overall significance level of 0.05. Results: RTOG 0515 accrued 52 patients, 47 of whom are evaluable. The follow-up time for all patients is 12.9 months (2.7-22.2). Tumor staging was as follows: II = 6{\%}; IIIA = 40{\%}; and IIIB = 54{\%}. The GTV was statistically significantly smaller for PET/CT-derived volumes (98.7 vs. 86.2 mL; p < 0.0001). MLDs for PET/CT plans were slightly lower (19 vs. 17.8 Gy; p = 0.06). There was no significant difference in the number of involved nodes (2.1 vs. 2.4), V20 (32{\%} vs. 30.8{\%}), or MED (28.7 vs. 27.1 Gy). Nodal contours were altered by PET/CT for 51{\%} of patients. One patient (2{\%}) has developed an elective nodal failure. Conclusions: PET/CT-derived tumor volumes were smaller than those derived by CT alone. PET/CT changed nodal GTV contours in 51{\%} of patients. The elective nodal failure rate for GTVs derived by PET/CT is quite low, supporting the RTOG standard of limiting the target volume to the primary tumor and involved nodes.",
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author = "Jeffrey Bradley and Kyounghwa Bae and Noah Choi and Ken Forster and Siegel, {Barry A.} and Jacqueline Brunetti and James Purdy and Sergio Faria and Toni Vu and Wade Thorstad and Hak Choy",
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T2 - Primary analysis of Radiation Therapy Oncology Group (RTOG) 0515

AU - Bradley, Jeffrey

AU - Bae, Kyounghwa

AU - Choi, Noah

AU - Forster, Ken

AU - Siegel, Barry A.

AU - Brunetti, Jacqueline

AU - Purdy, James

AU - Faria, Sergio

AU - Vu, Toni

AU - Thorstad, Wade

AU - Choy, Hak

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N2 - Background: Radiation Therapy Oncology Group (RTOG) 0515 is a Phase II prospective trial designed to quantify the impact of positron emission tomography (PET)/computed tomography (CT) compared with CT alone on radiation treatment plans (RTPs) and to determine the rate of elective nodal failure for PET/CT-derived volumes. Methods: Each enrolled patient underwent definitive radiation therapy for non-small-cell lung cancer (≥60 Gy) and had two RTP datasets generated: gross tumor volume (GTV) derived with CT alone and with PET/CT. Patients received treatment using the PET/CT-derived plan. The primary end point, the impact of PET/CT fusion on treatment plans was measured by differences of the following variables for each patient: GTV, number of involved nodes, nodal station, mean lung dose (MLD), volume of lung exceeding 20 Gy (V20), and mean esophageal dose (MED). Regional failure rate was a secondary end point. The nonparametric Wilcoxon matched-pairs signed-ranks test was used with Bonferroni adjustment for an overall significance level of 0.05. Results: RTOG 0515 accrued 52 patients, 47 of whom are evaluable. The follow-up time for all patients is 12.9 months (2.7-22.2). Tumor staging was as follows: II = 6%; IIIA = 40%; and IIIB = 54%. The GTV was statistically significantly smaller for PET/CT-derived volumes (98.7 vs. 86.2 mL; p < 0.0001). MLDs for PET/CT plans were slightly lower (19 vs. 17.8 Gy; p = 0.06). There was no significant difference in the number of involved nodes (2.1 vs. 2.4), V20 (32% vs. 30.8%), or MED (28.7 vs. 27.1 Gy). Nodal contours were altered by PET/CT for 51% of patients. One patient (2%) has developed an elective nodal failure. Conclusions: PET/CT-derived tumor volumes were smaller than those derived by CT alone. PET/CT changed nodal GTV contours in 51% of patients. The elective nodal failure rate for GTVs derived by PET/CT is quite low, supporting the RTOG standard of limiting the target volume to the primary tumor and involved nodes.

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