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CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(06): E496-E504
DOI: 10.1055/s-0043-104861
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Fiducial markers coupled with 3D PET/CT offer more accurate radiation treatment delivery for locally advanced esophageal cancer

Jasmine A. Oliver
1   H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, USA
2   University of South Florida, Department of Physics, Tampa, FL, USA
,
Puja Venkat
1   H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, USA
,
Jessica M. Frakes
1   H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, USA
,
Jason Klapman
3   H. Lee Moffitt Cancer Center and Research Institute, Gastrointestinal Tumor Program, Division of Endoscopic Oncology, Tampa, FL, USA
,
Cynthia Harris
3   H. Lee Moffitt Cancer Center and Research Institute, Gastrointestinal Tumor Program, Division of Endoscopic Oncology, Tampa, FL, USA
,
Jaime Montilla-Soler
4   H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
,
Gautamy C. Dhadham
3   H. Lee Moffitt Cancer Center and Research Institute, Gastrointestinal Tumor Program, Division of Endoscopic Oncology, Tampa, FL, USA
,
Baderaldeen A. Altazi
1   H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, USA
2   University of South Florida, Department of Physics, Tampa, FL, USA
,
Geoffrey G. Zhang
1   H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, USA
2   University of South Florida, Department of Physics, Tampa, FL, USA
,
Eduardo G. Moros
1   H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, USA
2   University of South Florida, Department of Physics, Tampa, FL, USA
,
Ravi Shridhar
5   Florida Hospital Cancer Institute, Orlando, FL, USA
,
Sarah E. Hoffe
1   H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, USA
,
Kujtim Latifi
1   H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, USA
2   University of South Florida, Department of Physics, Tampa, FL, USA
› Author Affiliations
Further Information

Publication History

submitted 08 September 2016

accepted after revision 01 February 2017

Publication Date:
31 May 2017 (online)

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Abstract

Background and aims The role of three-dimensional positron emission tomography/computed tomography (3 D PET/CT) in esophageal tumors that move with respiration and have potential for significant mucosal inflammation is unclear. The aim of this study was to determine the correlation between gross tumor volumes derived from 3 D PET/CT and endoscopically placed fiducial markers.

Methods This was a retrospective, IRB approved analysis of 40 patients with esophageal cancer with fiducials implanted and PET/CT. The centroid of each fiducial was identified on PET/CT images. Distance between tumor volume and fiducials was measured using axial slices. Image features were extracted and tested for pathologic response predictability.

Results The median adaptively calculated threshold value of the standardized uptake value (SUV) to define the metabolic tumor volume (MTV) border was 2.50, which corresponded to a median 23 % of the maximum SUV. The median distance between the inferior fiducial centroid and MTV was – 0.60 cm (– 3.9 to 2.7 cm). The median distance between the superior fiducial centroid and MTV was 1.25 cm (– 4.2 to 6.9 cm). There was no correlation between MTV-to-fiducial distances greater than 2 cm and the gastroenterologist who performed the fiducial implantation. Eccentricity demonstrated statistically significant correlations with pathologic response.

Conclusions There was a stronger correlation between inferior fiducial location and MTV border compared to the superior extent. The etiology of the discordance superiorly is unclear, potentially representing benign secondary esophagitis, presence of malignant nodes, inflammation caused by technical aspects of the fiducial placement itself, or potential submucosal disease. Given the concordance inferiorly and the ability to more precisely set up the patient with daily image guidance matching to fiducials, it may be possible to minimize the planning tumor volume (PTV) margin in select patients, thereby, limiting dose to normal structures.

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2017; 49(07): 723-723
DOI: 10.1055/s-0043-111207

 

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