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Geometrical Differences in Target Volumes Between 18FDG PET-CT and 4-Dimensional CT MIP Images of Primary Esophageal Cancer for Radiation Treatment
S342
International Journal of Radiation Oncology Biology Physics
initiated to assess radiation-induced heart disease (RIHD) during-RT (at 40Gy) using gated 99mTc-sestamibi (MIBI) single photon emission computed tomography (SPECT) in patients with esophageal cancer. This ongoing study aimed to investigate the value of 99mTc-MIBI SPECT in the detection of RIHD as early as during-RT. Furthermore, early detection might guide the following RT plans to minimize the dose to the heart, ultimately reduce the RIHD. To our knowledge, this study is the first to show that RIHD may be detected by myocardial perfusion imaging during-RT. Materials/Methods: Gated 99mTc-MIBI SPECT was performed before and during-RT (at 40Gy), while the total dose would reach 60-65Gy. The results of SPECT were semi-quantitative analyzed with QGS/QPS software and read by multiple experienced nuclear medicine doctors respectively. QGS was used for calculating end-diastolic volume (EDV), end-systolic volume (ESV), LVEF, WT, WM, peak ejection rate (PER), peak filling rate (PFR), one-third mean filling rate (MFR/3), time to PFR (TTPF), wall thickening (WT) and motion (WM), end diastolic perfusion (EDP), end systolic perfusion (ESP). Regional WT, WM, EDP, ESP were evaluated based on 20-segments of a polar bulls-eye plot. Visual analysis and QPS were used for evaluating distribution of the myocardial perfusion. 8 patients with advanced middle and distal esophageal squamous carcinoma confirmed by pathological diagnosis, eligible for RT (three 3D-CRT and five IMRT), were included. Results: The preliminary results showed that not only significant increase of EDV and significant decreases of PFR, EDP (3/20 segments), ESP(3/20 segments), WT(2/20 segments) and WM(6/20 segments) were observed compared to baseline(p<0.05) respectively, but also new perfusion defects were observed in left ventricular of 6 patients when they received the dose as 40Gy. By regression analysis, correlation coefficients of decease in EDP and V50, V55,V60 were excellent respectively (r0.95) as well as ESP. Conclusions: Gated 99mTc-MIBI SPECT can monitor the cardiotoxicity in asymptomatic patients with possible RIHD during-RT. EDV, PFR, EDP, ESP, WT and WM might be valuable as early indicators of ventricular dysfunction due to RIHD. V50, V55, V60 may be important factors for early RIHD. Author Disclosure: P. Zhang: None. X. Hu: None. J. Yue: None. G. Yang: None. X. Wang: None. X. Meng: None. X. Sun: None. J. Yu: None.
volume ratios of IGTVPET2.5 to IGTV10, IGTVPET20% to IGTV10 were 0.920.29, 0.910.28, respectively. The CIs of IGTVPET2.0 vs IGTV10, IGTVPET2.5 vs IGTV10, IGTVPET20% vs IGTV10 were 0.530.14, 0.520.11, 0.530.13, respectively (P > 0.05). No statistical significance existed in the DIs of IGTV10 in IGTVPET2.5 (0.670.19), IGTV10 in IGTVPET20% (0.700.12) (P>0.05). The DIs of IGTVPET2.5 in IGTV10(0.720.19)and IGTVPET20% in IGTV10 (0.740.11) also showed no statistical significance (P > 0.05). Conclusions: The IGTV contoured by SUV threshold settings of 2.5 or 20% of SUVmax corresponded better with the IGTV which was combined by GTVs contoured on ten phases of 4DCT, and achieved relatively better spatial matching degree. Author Disclosure: Y. Guo: None. L. Jianbin: None. Z. Yingjie: None. W. Wei: None. S. Dongping: None. F. Zheng: None.
2315 Defining Target Volumes for Radiation Treatment of Primary Esophageal Cancer: A Comparison of 4-Dimensional CT and 18FDG PET-CT Y. Guo,1 L. Jianbin,2 Z. Yingjie,2 W. Wei,2 S. Dongping,3 and F. Zheng3; 1 Department of Radiation Oncology (Chest Section), Shandong Cancer Hospital and Institute, Jinan, China, 2Department of Radiation Oncology (Chest Section) Shandong Tumor Hospital and Institute, Jinan, China, 3 Department of Medical Physics, Shandong Cancer Hospital and Institute, Jinan, China Purpose/Objective(s): To compare volume, conformity index (CI), degree of inclusion (DI) of internal gross target volumes (IGTV) delineated on four-dimensional CT (4DCT) and PET-CT images for primary esophageal cancer. Materials/Methods: Fifteen patients with thoracic esophageal cancer sequentially performed 3DCT, 4DCT and 18FDG PET-CT simulation. The gross target volumes (GTVs) of ten phases of 4DCT were contoured, and IGTV10 was obtained by combining the ten GTVs. The PET contours were determined with different SUV (standardized uptake value) threshold methods :SUV 2.0, 2.5, 3.0, 3.5; or 20%, 25%, 30%, 35%, 40% of the maximal tumor SUV (SUVmax), and were defined as IGTVPET2.0, IGTVPET2.5, IGTVPET3.0, IGTVPET3.5, IGTVPET20%, IGTVPET25%, IGTVPET30%, IGTVPET35%, IGTVPET40%, respectively. The differences in volume, conformity index (CI),degree of inclusion (DI) of target volumes were compared. Results: No statistical significance was observed between the volume of IGTV10 and IGTVPET2.5, IGTV10 and IGTVPET20% (P > 0.05). The
2316 Geometrical Differences in Target Volumes Between 18FDG PET-CT and 4-Dimensional CT MIP Images of Primary Esophageal Cancer for Radiation Treatment Y. Guo,1 L. Jianbin,1 W. Wei,1 Z. Yingjie,1 S. Dongping,2 and F. Zheng3; 1 Department of Radiation Oncology (Chest Section), Shandong Cancer Hospital and Institute, Jinan, China, 2Department of Medical physics, Shandong Cancer Hospital and Institute, Jinan, China, 3Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, China Purpose/Objective(s): To compare volumetric size, conformity index (CI), degree of inclusion (DI) of internal gross target volumes (IGTV) delineated on 4DCT-MIP and PET-CT images for primary esophageal cancer. Materials/Methods: Fifteen patients with thoracic esophageal cancer sequentially performed enhanced 3DCT, 4DCT and PET-CT simulation scans. The gross tumor volumes (GTVs) of ten phases of 4DCT were contoured, and IGTVMIP was obtained by contouring on 4DCT maximum intensity projection (MIP). The PET contours were determined with nine different threshold methods (SUV 2.0, 2.5, 3.0, 3.5; 20%, 25%, 30%, 35%, 40% of the SUVmax) and manual contours, which were defined as IGTVPET2.0, IGTVPET2.5, IGTVPET3.0, IGTVPET3.5, IGTVPET20%, IGTVPET25%, IGTVPET30%, IGTVPET35%, IGTVPET40%, IGTVPETMAN, respectively. The differences in size, conformity index (CI), degree of inclusion (DI) of different volumes were compared. Results: The volumetric size of IGTVPET2.0 was significantly larger than that of IGTVMIP (P<0.05) and the volume ratio of IGTVPET2.0 to IGTVMIP was 1.22. The volume ratios of IGTVPET2.5 to IGTVMIP, IGTVPET20% to IGTVMIP, IGTVPETMAN to IGTVMIP were 0 .86, 0.88, 1.06, respectively which showed no statistical significance between each other (P > 0.05). Other IGTVPET volumes were significantly smaller than that of IGTVMIP (P < 0.05). The CIs of IGTVPET2.0 vs IGTVMIP, IGTVPET2.5 vs IGTVMIP, IGTVPET20% vs IGTVMIP, IGTVPETMAN to IGTVMIP were 0.55, 0.56, 0.56, 0.55 respectively (P > 0.05). No statistical significance existed in the DIs of IGTVMIP in IGTVPET2.5 (0.77), IGTVMIP in IGTVPET20% (0.82), IGTVMIP in IGTVPETMAN (0.71) (P>0.05). The DIs of IGTVPET2.5 in IGTVMIP (0.67), IGTVPET20% in IGTVMIP (0.68), IGTVPETMAN in IGTVMIP (0.82) also showed no statistical significance (P > 0.05). Conclusions: The IGTV contoured by SUV threshold settings of 2.5 or 20% SUVmax or the manual contours corresponded better with the IGTV which was contoured based on 4DCT-MIP in volumetric size, and with relatively better spatial matching degree. Author Disclosure: Y. Guo: None. L. Jianbin: None. W. Wei: None. Z. Yingjie: None. S. Dongping: None. F. Zheng: None.
2317 Detection of the Factors That Influence the Correlation of Target Volumes for Primary Esophageal Cancer Based on PET-CT and EndExpiration Phase of 4-Dimensional CT in Radiation Treatment Y. Guo,1 L. Jianbin,1 Z. Yingjie,1 W. Jinzhi,1 S. Dongping,2 and F. Zheng3; 1 Department of Radiation Oncology (Chest Section), Shandong Cancer Hospital and Institute, Jinan, China, 2Department of Medical physics,
International Journal of Radiation Oncology Biology Physics
initiated to assess radiation-induced heart disease (RIHD) during-RT (at 40Gy) using gated 99mTc-sestamibi (MIBI) single photon emission computed tomography (SPECT) in patients with esophageal cancer. This ongoing study aimed to investigate the value of 99mTc-MIBI SPECT in the detection of RIHD as early as during-RT. Furthermore, early detection might guide the following RT plans to minimize the dose to the heart, ultimately reduce the RIHD. To our knowledge, this study is the first to show that RIHD may be detected by myocardial perfusion imaging during-RT. Materials/Methods: Gated 99mTc-MIBI SPECT was performed before and during-RT (at 40Gy), while the total dose would reach 60-65Gy. The results of SPECT were semi-quantitative analyzed with QGS/QPS software and read by multiple experienced nuclear medicine doctors respectively. QGS was used for calculating end-diastolic volume (EDV), end-systolic volume (ESV), LVEF, WT, WM, peak ejection rate (PER), peak filling rate (PFR), one-third mean filling rate (MFR/3), time to PFR (TTPF), wall thickening (WT) and motion (WM), end diastolic perfusion (EDP), end systolic perfusion (ESP). Regional WT, WM, EDP, ESP were evaluated based on 20-segments of a polar bulls-eye plot. Visual analysis and QPS were used for evaluating distribution of the myocardial perfusion. 8 patients with advanced middle and distal esophageal squamous carcinoma confirmed by pathological diagnosis, eligible for RT (three 3D-CRT and five IMRT), were included. Results: The preliminary results showed that not only significant increase of EDV and significant decreases of PFR, EDP (3/20 segments), ESP(3/20 segments), WT(2/20 segments) and WM(6/20 segments) were observed compared to baseline(p<0.05) respectively, but also new perfusion defects were observed in left ventricular of 6 patients when they received the dose as 40Gy. By regression analysis, correlation coefficients of decease in EDP and V50, V55,V60 were excellent respectively (r0.95) as well as ESP. Conclusions: Gated 99mTc-MIBI SPECT can monitor the cardiotoxicity in asymptomatic patients with possible RIHD during-RT. EDV, PFR, EDP, ESP, WT and WM might be valuable as early indicators of ventricular dysfunction due to RIHD. V50, V55, V60 may be important factors for early RIHD. Author Disclosure: P. Zhang: None. X. Hu: None. J. Yue: None. G. Yang: None. X. Wang: None. X. Meng: None. X. Sun: None. J. Yu: None.
volume ratios of IGTVPET2.5 to IGTV10, IGTVPET20% to IGTV10 were 0.920.29, 0.910.28, respectively. The CIs of IGTVPET2.0 vs IGTV10, IGTVPET2.5 vs IGTV10, IGTVPET20% vs IGTV10 were 0.530.14, 0.520.11, 0.530.13, respectively (P > 0.05). No statistical significance existed in the DIs of IGTV10 in IGTVPET2.5 (0.670.19), IGTV10 in IGTVPET20% (0.700.12) (P>0.05). The DIs of IGTVPET2.5 in IGTV10(0.720.19)and IGTVPET20% in IGTV10 (0.740.11) also showed no statistical significance (P > 0.05). Conclusions: The IGTV contoured by SUV threshold settings of 2.5 or 20% of SUVmax corresponded better with the IGTV which was combined by GTVs contoured on ten phases of 4DCT, and achieved relatively better spatial matching degree. Author Disclosure: Y. Guo: None. L. Jianbin: None. Z. Yingjie: None. W. Wei: None. S. Dongping: None. F. Zheng: None.
2315 Defining Target Volumes for Radiation Treatment of Primary Esophageal Cancer: A Comparison of 4-Dimensional CT and 18FDG PET-CT Y. Guo,1 L. Jianbin,2 Z. Yingjie,2 W. Wei,2 S. Dongping,3 and F. Zheng3; 1 Department of Radiation Oncology (Chest Section), Shandong Cancer Hospital and Institute, Jinan, China, 2Department of Radiation Oncology (Chest Section) Shandong Tumor Hospital and Institute, Jinan, China, 3 Department of Medical Physics, Shandong Cancer Hospital and Institute, Jinan, China Purpose/Objective(s): To compare volume, conformity index (CI), degree of inclusion (DI) of internal gross target volumes (IGTV) delineated on four-dimensional CT (4DCT) and PET-CT images for primary esophageal cancer. Materials/Methods: Fifteen patients with thoracic esophageal cancer sequentially performed 3DCT, 4DCT and 18FDG PET-CT simulation. The gross target volumes (GTVs) of ten phases of 4DCT were contoured, and IGTV10 was obtained by combining the ten GTVs. The PET contours were determined with different SUV (standardized uptake value) threshold methods :SUV 2.0, 2.5, 3.0, 3.5; or 20%, 25%, 30%, 35%, 40% of the maximal tumor SUV (SUVmax), and were defined as IGTVPET2.0, IGTVPET2.5, IGTVPET3.0, IGTVPET3.5, IGTVPET20%, IGTVPET25%, IGTVPET30%, IGTVPET35%, IGTVPET40%, respectively. The differences in volume, conformity index (CI),degree of inclusion (DI) of target volumes were compared. Results: No statistical significance was observed between the volume of IGTV10 and IGTVPET2.5, IGTV10 and IGTVPET20% (P > 0.05). The
2316 Geometrical Differences in Target Volumes Between 18FDG PET-CT and 4-Dimensional CT MIP Images of Primary Esophageal Cancer for Radiation Treatment Y. Guo,1 L. Jianbin,1 W. Wei,1 Z. Yingjie,1 S. Dongping,2 and F. Zheng3; 1 Department of Radiation Oncology (Chest Section), Shandong Cancer Hospital and Institute, Jinan, China, 2Department of Medical physics, Shandong Cancer Hospital and Institute, Jinan, China, 3Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, China Purpose/Objective(s): To compare volumetric size, conformity index (CI), degree of inclusion (DI) of internal gross target volumes (IGTV) delineated on 4DCT-MIP and PET-CT images for primary esophageal cancer. Materials/Methods: Fifteen patients with thoracic esophageal cancer sequentially performed enhanced 3DCT, 4DCT and PET-CT simulation scans. The gross tumor volumes (GTVs) of ten phases of 4DCT were contoured, and IGTVMIP was obtained by contouring on 4DCT maximum intensity projection (MIP). The PET contours were determined with nine different threshold methods (SUV 2.0, 2.5, 3.0, 3.5; 20%, 25%, 30%, 35%, 40% of the SUVmax) and manual contours, which were defined as IGTVPET2.0, IGTVPET2.5, IGTVPET3.0, IGTVPET3.5, IGTVPET20%, IGTVPET25%, IGTVPET30%, IGTVPET35%, IGTVPET40%, IGTVPETMAN, respectively. The differences in size, conformity index (CI), degree of inclusion (DI) of different volumes were compared. Results: The volumetric size of IGTVPET2.0 was significantly larger than that of IGTVMIP (P<0.05) and the volume ratio of IGTVPET2.0 to IGTVMIP was 1.22. The volume ratios of IGTVPET2.5 to IGTVMIP, IGTVPET20% to IGTVMIP, IGTVPETMAN to IGTVMIP were 0 .86, 0.88, 1.06, respectively which showed no statistical significance between each other (P > 0.05). Other IGTVPET volumes were significantly smaller than that of IGTVMIP (P < 0.05). The CIs of IGTVPET2.0 vs IGTVMIP, IGTVPET2.5 vs IGTVMIP, IGTVPET20% vs IGTVMIP, IGTVPETMAN to IGTVMIP were 0.55, 0.56, 0.56, 0.55 respectively (P > 0.05). No statistical significance existed in the DIs of IGTVMIP in IGTVPET2.5 (0.77), IGTVMIP in IGTVPET20% (0.82), IGTVMIP in IGTVPETMAN (0.71) (P>0.05). The DIs of IGTVPET2.5 in IGTVMIP (0.67), IGTVPET20% in IGTVMIP (0.68), IGTVPETMAN in IGTVMIP (0.82) also showed no statistical significance (P > 0.05). Conclusions: The IGTV contoured by SUV threshold settings of 2.5 or 20% SUVmax or the manual contours corresponded better with the IGTV which was contoured based on 4DCT-MIP in volumetric size, and with relatively better spatial matching degree. Author Disclosure: Y. Guo: None. L. Jianbin: None. W. Wei: None. Z. Yingjie: None. S. Dongping: None. F. Zheng: None.
2317 Detection of the Factors That Influence the Correlation of Target Volumes for Primary Esophageal Cancer Based on PET-CT and EndExpiration Phase of 4-Dimensional CT in Radiation Treatment Y. Guo,1 L. Jianbin,1 Z. Yingjie,1 W. Jinzhi,1 S. Dongping,2 and F. Zheng3; 1 Department of Radiation Oncology (Chest Section), Shandong Cancer Hospital and Institute, Jinan, China, 2Department of Medical physics,