%0 Journal Article
%T Challenges and opportunities in patient-specific, motion-managed and PET/CT-guided radiation therapy of lung cancer: review and perspective
%A Stephen R Bowen
%A Matthew J Nyflot
%A Michael Gensheimer
%A Kristi R G Hendrickson
%A Paul E Kinahan
%A George A Sandison
%A Shilpen A Patel
%J Clinical and Translational Medicine
%D 2012
%I Springer
%R 10.1186/2001-1326-1-18
%X Lung cancer is the leading cause of cancer mortality worldwide, resulting in 1.4 million deaths annually [1]. At the time of presentation, non-small cell lung cancer has often spread to multiple mediastinal lymph nodes and can no longer be successfully resected. Concurrent chemoradiation therapy is a mainstay of locally advanced lung cancer treatment, but standard-of-care regimens suffer from local failure rates as high as 85 percent for advanced stage non-small cell lung cancer patients [2]. Among other contributing factors, the potential efficacy of radiotherapy in these patients is compromised by uncertainty in lesion and normal tissue delineation due to respiratory-induced tumor motion, which has limited the precise planning and delivery of curative doses. Time-dependent computed tomography (CT) and positron emission tomography (PET) has the ability to resolve this motion and therefore define the extent of disease, both anatomically and functionally. In addition, the achievable therapeutic ratio of radiotherapy may be improved by image-guided dose intensification to PET-defined biological target volumes that are at highest risk of recurrence, and dose sparing of functional lung volumes that are at highest risk of complication. The application of motion-managed PET/CT to radiotherapy planning coupled with motion-managed and image-guided delivery will further individualize radiation oncology care of lung cancer patients.Imaging with PET/CT is becoming a standard-of-care in the staging of lung cancers, but it is still underutilized in its direct integration to radiotherapy planning. Target volumes and uncertainty margins derived from PET imaging have been used without established consensus due to the complexity of the image formation process that yields quantitative radiotracer uptake information. Likewise, no consensus exists on optimal motion management techniques that can both reduce respiratory motion-induced image blurring and artifacts in PET/CT images of lun
%K PET
%K FDG
%K Respiratory gating
%K Respiratory tracking
%K IMRT
%K IGRT
%K Adaptive radiotherapy
%U http://www.clintransmed.com/content/1/1/18