Background/Objectives:Lung cancer is the leading cause of cancer-related mortality worldwide. Accurate radiotherapy (RT) planning alongside chemotherapy and immunotherapy is critical for improving treatment outcomes for inoperable non-metastatic cases. Conventional computed tomography (CT)-based planning may be inadequate for accurately identifying tumor margins and the location of nodal disease. We investigated whether18F-labeled fluorodeoxyglucose positron emission tomography (18F-FDG PET-CT) imaging can assist in target volume delineation for primary, nodal, and metastatic disease in the RT planning and overall therapeutic planning of patients.Methods: In this single-center, prospective study, we recruited 34 patients with histologically confirmed locally advanced non-small-cell lung carcinoma (NSCLC). All patients underwent18F-FDG PET-CT-based RT simulation. Two sequential RT plans were created by the same radiation oncologist: one based on CT alone and the other PET-CT. Planning target volumes (PTVs) and PET-CT-guided adjustments were analyzed to assess their impact. Standardized protocols for immobilization, imaging, target delineation, and dose prescription were applied.Results: A total of 34 patients (31 males and 3 females) were recruited in the study.18F-FDG PET-CT detected distant metastases in 7/34 (20.6%) patients, altering the overall therapeutic plan in 4/34 (11.8%) and allowing radical RT in 3 of them who had oligometastatic disease (8.8%). It modified RT planning in 26/34 (76.5%) patients and clarified malignancy in atelectatic areas. Nodal involvement was identified in 3/34 patients (8.8%) and excluded in 3/34 cases, avoiding unnecessary nodal irradiation. Additional involved nodes were revealed in 12/34 (35.3%) patients, requiring dose escalation. Overall, changes to the tumor PTV were made in 23/30 (76.6%) and to the nodal PTV in 19/30 (63.3%) cases (p< 0.0001). Primary tumor and nodal PTVs increased in 20/34 (66.7%) and 13/34 (43.3%), respectively.Conclusions:18F-FDG PET-CT significantly improves RT planning by more precisely defining tumor and nodal volumes, identifying undetected lesions, and guiding dose adaptation. Larger long-term studies are required to confirm potential locoregional control and survival improvements.
背景/目的：肺癌是全球癌症相关死亡的主要原因。对于无法手术的非转移性病例，精确的放射治疗（RT）计划结合化疗和免疫治疗对改善治疗效果至关重要。传统的基于计算机断层扫描（CT）的计划可能不足以准确识别肿瘤边缘和淋巴结病变位置。本研究探讨了¹⁸F标记的氟代脱氧葡萄糖正电子发射断层扫描（¹⁸F-FDG PET-CT）成像是否有助于在患者RT计划和整体治疗计划中，对原发灶、淋巴结及转移灶的靶区勾画提供辅助。 方法：在这项单中心前瞻性研究中，我们招募了34例经组织学确诊的局部晚期非小细胞肺癌（NSCLC）患者。所有患者均接受了基于¹⁸F-FDG PET-CT的RT模拟定位。由同一位放射肿瘤科医生制定了两个连续的RT计划：一个仅基于CT，另一个基于PET-CT。通过分析计划靶体积（PTVs）及PET-CT引导的调整，评估其影响。研究采用了标准化的固定、成像、靶区勾画和剂量处方方案。 结果：研究共招募34例患者（31例男性，3例女性）。¹⁸F-FDG PET-CT在7/34例（20.6%）患者中检测到远处转移，改变了4/34例（11.8%）患者的整体治疗计划，并使其中3例寡转移患者（8.8%）得以接受根治性RT。该技术修改了26/34例（76.5%）患者的RT计划，并明确了肺不张区域的恶性性质。在3/34例（8.8%）患者中确认了淋巴结受累，并在另外3/34例中排除了淋巴结受累，从而避免了不必要的淋巴结照射。在12/34例（35.3%）患者中发现了额外的受累淋巴结，需要进行剂量提升。总体而言，在23/30例（76.6%）中调整了肿瘤PTV，在19/30例（63.3%）中调整了淋巴结PTV（p < 0.0001）。原发肿瘤和淋巴结PTV分别增加了20/34例（66.7%）和13/34例（43.3%）。 结论：¹⁸F-FDG PET-CT通过更精确地定义肿瘤和淋巴结体积、识别未检测到的病灶以及指导剂量调整，显著改善了RT计划。需要更大规模的长期研究来确认其潜在的局部区域控制和生存获益。
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