REVIEW  MOLECULAR PET IMAGING IN ADAPTIVE RADIOTHERAPY 

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2018 December;62(4):385-403

DOI: 10.23736/S1824-4785.18.03081-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

PET imaging in adaptive radiotherapy of gastrointestinal tumors

Philippe BULENS ^{1, 2}, Melissa THOMAS ^{1, 2}, Christophe M. DEROOSE ^{3, 4}, Karin HAUSTERMANS ^{1, 2} ✉

¹ Department of Oncology, KU Leuven-University of Leuven, Leuven, Belgium; ² Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; ³ Department of Imaging & Pathology, KU Leuven-University of Leuven, Leuven, Belgium; ⁴ Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium

INTRODUCTION: Radiotherapy is a cornerstone in the multimodality treatment of several gastrointestinal (GI) tumors. Positron-emission tomography (PET) has an established role in the diagnosis, response assessment and (re-)staging of these tumors. Nevertheless, the value of PET in adaptive radiotherapy remains unclear. This review focuses on the role of PET in adaptive radiotherapy, i.e. during the treatment course and in the delineation process.
EVIDENCE ACQUISITION: The MEDLINE database was searched for the terms (“Radiotherapy”[Mesh] AND “Positron-Emission Tomography”[Mesh] AND one of the site-specific keywords, yielding a total of 1710 articles. After abstract selection, 27 papers were identified for esophageal neoplasms, 1 for gastric neoplasms, 9 for pancreatic neoplasms, 6 for liver neoplasms, 1 for biliary tract neoplasms, none for colonic neoplasms, 15 for rectal neoplasms and 12 for anus neoplasms.
EVIDENCE SYNTHESIS: The use of PET for truly adaptive radiotherapy during treatment for GI tumors has barely been investigated, in contrast to the potential of the PET-defined metabolic tumor volume for optimization of the target volume. The optimized target definition seems useful for treatment individualization such as focal boosting strategies in esophageal, pancreatic and anorectal cancer. Nevertheless, for all GI tumors, further investigation is needed.
CONCLUSIONS: In general, too little data are available to conclude on the role of PET imaging during radiotherapy for ART strategies in GI cancer. On the other hand, based on the available evidence, the use of biological imaging for target volume adaptation seems promising and could pave the road towards individualized treatment strategies.

KEY WORDS: Positron-emission tomography - Radiotherapy - Gastrointestinal tract