A new role of PET/CT for target delineation for radiotherapy treatment planning for head and neck carcinomas

Abstract

Fluorine-18-fluorodeoxyglucose- positron emission tomography (F-18-FDG PET) in head and neck cancer patients is useful for staging, identification of macroscopic disease, detection of invaded lymph nodes and distant metastases, delineation of radiotherapy target volume and assessment of treatment response. This brief review addresses the potential role of PET in radiotherapy planning as compared to MRI and CT scan. Positron emission tomography is considered by radiation oncologists a useful test for the identification of the specific target volume for treatment. In addition, a number of hypoxia-related PET radiopharmaceuticals such as the fluorine-18-fluoromisonidazole (F-18-FMISO) and the fluorine-18-fluoroazomycin arabinoside (F-18-FAZA) are now available in order to identify hypoxic tumor subvolumes helping to implement new radiotherapy techniques. Magnetic resonance imaging (MRI) has the advantage to discriminate the soft tissue contrast from the tumor, against computerized tomography (CT), but PET/CT scans have the additional advantage to incorporate the metabolic imaging for improving the delineation of variable and hypoxic tumor tissue in the head and neck region. Regardless of the method used for determining the gross tumor volume, clinical examination remains irreplaceable. In conclusion, PET/CT offers complementary information for the delineation of the primary tumor and the corresponding lymph nodes compared to the use of MRI and CT and can support the use of modern radiotherapy techniques, having fewer toxicities.