Definitif radyoterapi uygulanan baş-boyun kanserli olgularda PET/BT'nin tedavi planlamasındaki rolü
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Date
2013
Authors
Arslan, Sonay
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Publisher
Uludağ Üniversitesi
Abstract
Çalışmamızda Flor-18 Deoksiglukoz pozitron emisyon tomografi/bilgisayarlı tomografi (FDG-PET/BT)'nin, definitif radyoterapi (RT) uygulanan baş-boyun kanserli olgularda, evreleme ve radyoterapi planlamasına katkısını değerlendirmeyi amaçladık. Uludağ Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalı'nda baş-boyun kanseri tanısı ile definitif radyoterapi uygulanan ve PET/BT görüntülemesi yapılan 37 olgu PET/BT'nin evreleme ve radyoterapi planlamasındaki rolünü belirlemek üzere irdelendi. Olguların 32'si erkek ve 5'i kadın olup median yaş 57 (Sınırlar 13-84) idi. Olgular American Joint Committee on Cancer (AJCC) tarafından önerilen TNM sınıflandırmasına göre BT ve PET/BT ile ayrı ayrı evrelendirildi ve evre değişimleri incelendi. Ardından PET/BT?den yararlanılarak oluşturulan Görüntülenebilir Tümör Volüm (GTV)'leri yalnızca BT ile oluşturulanlarla karşılaştırıldı. Klinik ve BT bulgularıyla yapılan evrelemeyle karşılaştırıldığında, klinik ve PET/BT'nin, 37 olgunun 18'inde evreyi değiştirmediği, 5'inde evreyi azalttığı ve 14'ünde evreyi arttırdığı saptandı. Volüm çizimleri sonucunda özetle 37 olgunun 32'sinde (%86,5) BT'ye göre primer kitle ve lenf nodlarının matematiksel olarak GTV toplamı (GTVBT-Total), PET/BT'ye göre daha büyüktü. PET/BT'ye göre primer kitlenin GTV'si (GTVPET/BT), BT'ye göre primer kitlenin GTV'si (GTVBT) ile karşılaştırıldığında 37 olgunun 3'ünde büyük, 34'ünde küçük saptandı. PET/BT'ye göre lenf nodlarının GTV'si (GTVLNPET/BT), BT'ye göre lenf nodlarının GTV'si (GTVLNBT) ile karşılaştırıldığında 37 olgunun 20'sinde (%54) büyük, 12'sinde (%32,5) küçük saptandı. 5 olguda her iki görüntüleme yöntemince de patolojik lenf nodu saptanmadı. Çalışmamızda baş-boyun kanserli olgularda PET/BT'nin gerek tedavi öncesi evrelemede gerekse radyoterapi hedef volümlerinde önemli ölçüde değişikliğe yol açabileceğini göstermiş olup baş-boyun kanserli olgularda tedavi öncesi PET/BT ile değerlendirme yapılması önerilebilir.
In this study, we aimed to investigate the benefits of Flour-18 deoxyglucose positron emission tomography/computed tomography (FGD-PET/CT) imaging for staging and radiotherapy planning in patients with head and neck cancer who underwent definitive radiotherapy. 37 head and neck cancer patients who underwent definitive radiotherapy and PET/CT in Uludağ University Medical Faculty Department of Radiation Oncology were investigated in order to determine the role of PET/CT in staging and radiotherapy planning. Median age of this patient group was 57 (13-84) consisting 32 male and 5 female. All cases were staged according to American Joint Committee on Cancer (AJCC) TNM staging system based on both CT and PET/CT. Gross tumor volumes determined by only CT and only PET/CT were compared. When clinical and CT staging scores compared with PET/CT staging scores following results were obtained; stage was the same in 18 cases, decreased in 5 cases and increased in 14 cases with PET/CT imaging. Total GTV determined by CT (GTVCT-Total) were increased in 32 cases (86.5%) when compared to total GTV determined by PET/CT (GTVPET/CT-Total). GTV of primary tumor determined by PET/CT (GTVPET/CT) were found larger in 3 cases and smaller in 34 cases compared to GTV determined by CT (GTVCT). GTV of lymph nodes determined by PET/CT (GTVLNPET/CT) were larger in 20 cases (54%) and smaller in 12 cases (32.5%) when compared to GTV values determined by CT (GTVLNCT). No pathological lymph nodes were observed in remaining 5 cases with both CT and PET/CT. We can conclude that PET/CT can significantly affect both pretreatment staging and target tumor volume in patients with head and neck cancer. We can recommend examining head and neck cancer patients with PEC/CT before the treatment.
In this study, we aimed to investigate the benefits of Flour-18 deoxyglucose positron emission tomography/computed tomography (FGD-PET/CT) imaging for staging and radiotherapy planning in patients with head and neck cancer who underwent definitive radiotherapy. 37 head and neck cancer patients who underwent definitive radiotherapy and PET/CT in Uludağ University Medical Faculty Department of Radiation Oncology were investigated in order to determine the role of PET/CT in staging and radiotherapy planning. Median age of this patient group was 57 (13-84) consisting 32 male and 5 female. All cases were staged according to American Joint Committee on Cancer (AJCC) TNM staging system based on both CT and PET/CT. Gross tumor volumes determined by only CT and only PET/CT were compared. When clinical and CT staging scores compared with PET/CT staging scores following results were obtained; stage was the same in 18 cases, decreased in 5 cases and increased in 14 cases with PET/CT imaging. Total GTV determined by CT (GTVCT-Total) were increased in 32 cases (86.5%) when compared to total GTV determined by PET/CT (GTVPET/CT-Total). GTV of primary tumor determined by PET/CT (GTVPET/CT) were found larger in 3 cases and smaller in 34 cases compared to GTV determined by CT (GTVCT). GTV of lymph nodes determined by PET/CT (GTVLNPET/CT) were larger in 20 cases (54%) and smaller in 12 cases (32.5%) when compared to GTV values determined by CT (GTVLNCT). No pathological lymph nodes were observed in remaining 5 cases with both CT and PET/CT. We can conclude that PET/CT can significantly affect both pretreatment staging and target tumor volume in patients with head and neck cancer. We can recommend examining head and neck cancer patients with PEC/CT before the treatment.
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Keywords
Baş-boyun kanserleri, PET-BT, Radyoterapi, Head and neck cancer, PET-CT, Radiotherapy
Citation
Arslan, S. (2013). Definitif radyoterapi uygulanan baş-boyun kanserli olgularda PET/BT'nin tedavi planlamasındaki rolü. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.