Impact of 18-fluorodeoxyglucose positron emission tomography on computed tomography defined target volumes in radiation treatment planning of esophageal cancer: reduction in geographic misses with equal inter-observer variability: PET/CT improves esophageal target definition

L M A Schreurs, D M Busz, G M R M Paardekooper, J C Beukema, P L Jager, E J Van der Jagt, G M van Dam, H Groen, J Th M Plukker, J A Langendijk

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    Target volume definition in modern radiotherapy is based on planning computed tomography (CT). So far, 18-fluorodeoxyglucose positron emission tomography (FDG-PET) has not been included in planning modality in volume definition of esophageal cancer. This study evaluates fusion of FDG-PET and CT in patients with esophageal cancer in terms of geographic misses and inter-observer variability in volume definition. In 28 esophageal cancer patients, gross, clinical and planning tumor volumes (GTV; CTV; PTV) were defined on planning CT by three radiation oncologists. After software-based emission tomography and computed tomography (PET/CT) fusion, tumor delineations were redefined by the same radiation-oncologists. Concordance indexes (CCI's) for CT and PET/CT based GTV, CTV and PTV were calculated for each pair of observers. Incorporation of PET/CT modified tumor delineation in 17/28 subjects (61%) in cranial and/or caudal direction. Mean concordance indexes for CT-based CTV and PTV were 72 (55-86)% and 77 (61-88)%, respectively, vs. 72 (47-99)% and 76 (54-87)% for PET/CT-based CTV and PTV. Paired analyses showed no significant difference in CCI between CT and PET/CT. Combining FDG-PET and CT may improve target volume definition with less geographic misses, but without significant effects on inter-observer variability in esophageal cancer.

    Original languageEnglish
    Pages (from-to)493-501
    Number of pages9
    JournalDiseases of the esophagus
    Issue number6
    Publication statusPublished - Aug-2010


    • Aged
    • Aged, 80 and over
    • Esophageal Neoplasms/diagnostic imaging
    • Female
    • Fluorodeoxyglucose F18
    • Humans
    • Male
    • Middle Aged
    • Observer Variation
    • Positron-Emission Tomography/methods
    • Radiographic Image Interpretation, Computer-Assisted
    • Radiopharmaceuticals
    • Radiotherapy Planning, Computer-Assisted/methods
    • Radiotherapy, Conformal
    • Retrospective Studies
    • Tomography, X-Ray Computed/methods

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