PET/CT in der Strahlentherapie

Robert Krempien; Marc Münter; Stefan Dresel

doi:10.1055/a-0959-0635

Der Nuklearmediziner, Table of Contents

Der Nuklearmediziner 2020; 43(02): 167-183
DOI: 10.1055/a-0959-0635

Kopf-Hals-Tumore

PET/CT in der Strahlentherapie

PET/CT in radiotherapy

Authors

Robert Krempien

¹Klinik für Strahlentherapie, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin
Marc Münter

²Abt. Radioonkologie und Strahlentherapie, Radioonkologie und Strahlentherapie Klinikum der Landeshauptstadt Stuttgart, Katharinenhospital, Kriegsbergstraße 60, 70174 Stuttgart
Stefan Dresel

³Klinik für Nuklearmedizin, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin

Abstract

Zusammenfassung

Das therapeutische Konzept einer suffizienten Strahlentherapie ist die Applikation einer ausreichend hohen therapeutischen Dosis im anvisierten Zielvolumen bei gleichzeitiger maximaler Schonung des umgebenden Normalgewebes. Es zeigt sich jedoch mehr und mehr, dass die traditionellen Anatomie-basierten Schnittbildgebungen (CT, MRT) die Tumorausdehnung häufig über- oder unterbewerten. Seit der Einführung der Positronen-Emissions-Tomografie (PET) in die klinische Routine wird angestrebt, die morphologische Basis der Bestrahlungsplanungs-CT durch die funktionellen Informationen der PET zu ergänzen und somit zu einer biologisch funktionellen Bestrahlungsplanung zu gelangen. Durch eine präzise Koregistrierung der funktionellen, metabolischen Daten mit den für die Bestrahlungsplanung erforderlichen anatomischen Informationen aus den CT-Aufnahmen kommt die PET/CT-Technik den Anforderungen der Hochpräzisionsbestrahlung entscheidend entgegen. Klinische Studien bei nahezu allen Tumorentitäten zeigen einen erheblichen Einfluss der PET/CT auf die Konturierung der Zielvolumina. Erhebliche Änderungen zeigen sich in 20 % bis über 50 % der Fälle gegenüber rein CT-basierten Konturierungen. Im Folgenden haben wir die wesentlichen Daten in Bezug auf Staging und Zielvolumendefinition und soweit vorhanden auf Therapieansprechen zusammengefasst.

Abstract

The therapeutic concept of enough radiation therapy is the application of a sufficiently high therapeutic dose in the target volume with simultaneous maximum protection of the surrounding normal tissue. However, it is becoming increasingly apparent that traditional anatomy-based cross-sectional imaging (CT, MRI) often over- or underestimates tumor size. Since the introduction of positron emission tomography (PET) into the clinical routine, the aim is to supplement the morphological basis of the radiation planning CT with the functional information of the PET and thus to aim a biologically functional radiation planning. By precisely correlating the functional metabolic data with the anatomical information from the CT images required for treatment planning, the PET/CT technique decisively accommodates the requirements of high-precision irradiation. Clinical studies in almost all tumor entities show a significant influence of PET/CT on the contouring of the target volumes. Substantial changes occur in 20 % to more than 50 % of the cases compared to purely CT-based contouring. In the following, we summarized the main data related to staging and target volume definition and, if available, response to therapy.

Schlüsselwörter

PET/CT - Strahlentherapie

Keywords

PET/CT - radiotherapy

Full Text

References

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