Impact of PET on radiation therapy planning in lung cancer

The superiority of PET imaging to structural imaging in many cancers is rapidly transforming the practice of radiotherapy planning, especially in lung cancer. Although most lung cancers are potentially treatable with radiation therapy, only patients who have truly locoregionally confined disease can be cured by this modality. PET improves selection for high-dose radiation therapy by excluding many patients who have incurable distant metastasis or extensive locoregional spread. In those patients suitable for definitive treatment, PET can help shape the treatment fields to avoid geographic miss and minimize unnecessary irradiation of normal tissues. PET will allow for more accurately targeted dose escalation studies in the future and could potentially lead to better long-term survival.