PET/CT-guided radiation therapy planning: from present to the future

Area of Science:

• Oncology
• Medical Imaging
• Radiation Oncology

Background:

• 18F-fluoro-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is established for cancer diagnosis, staging, and response assessment.
• High-precision conformal radiotherapy has advanced treatment planning, minimizing dose to normal tissues.
• PET/CT fusion imaging is increasingly explored for radiotherapy planning, driven by its availability and integration capabilities.

Purpose of the Study:

• To review the promises and pitfalls of using FDG-PET/CT in radiotherapy treatment planning.
• To critically appraise the current evidence for PET/CT application in modern radiotherapy.
• To provide insights into the future of PET/CT in radiation oncology.

Main Methods:

• Review of current literature on FDG-PET/CT in radiotherapy planning.
• Critical appraisal of evidence for specific cancer types (lung, head and neck, cervical).
• Discussion of technical, administrative, and personnel challenges in clinical integration.

Main Results:

• Accumulating evidence suggests significant impact of PET/CT in radiotherapy planning for lung, head and neck, and cervical cancers.
• Widespread availability and integration with treatment planning systems stimulate enthusiasm for PET/CT-guided radiotherapy.
• Challenges in integrating PET/CT into routine practice include technical, administrative, financial, geographic, and personnel issues.

Conclusions:

• PET/CT offers significant potential to improve radiotherapy planning and delivery.
• Standardized guidelines and concerted efforts are needed to overcome integration challenges.
• Further development and research are crucial to fully realize the benefits of PET/CT in radiation oncology.