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Background  To evaluate the safety of focal dose escalation to regions with standardized uptake value (SUV) >2.0 using intensity-modulated radiation therapy (IMRT) by comparison of radiotherapy plans using dose-volume histograms (DVHs) and normal tissue complication probability (NTCP) for postoperative local recurrent rectal cancer    Methods  First, we performed conventional radiotherapy with 40 Gy/20 fr. (CRT 40 Gy) for 12 patients with postoperative local recurrent rectal cancer, and then we performed FDG-PET/CT radiotherapy planning for those patients. We defined the regions with SUV > 2.0 as biological target volume (BTV) and made three boost plans for each patient: 1) CRT boost plan, 2) IMRT without dose-painting boost plan, and 3) IMRT with dose-painting boost plan. The total boost dose was 20 Gy. In IMRT with dose-painting boost plan, we increased the dose for BTV+5 mm by 30% of the prescribed dose. We added CRT boost plan to CRT 40 Gy ( summed plan 1 ), IMRT without dose-painting boost plan to CRT 40 Gy ( summed plan 2 ) and IMRT with dose-painting boost plan to CRT 40 Gy ( summed plan 3 ), and we compared those plans using DVHs and NTCP.    Results  D mean  of PTV-PET and that of PTV-CT were 26.5 Gy and 21.3 Gy, respectively. V 50  of small bowel PRV in  summed plan 1  was significantly higher than those in other plans (( summed plan 1  vs.  summed plan 2  vs.  summed plan 3 : 47.11 ± 45.33 cm 3  vs. 40.63 ± 39.13 cm 3  vs. 41.25 ± 39.96 cm 3 (p < 0.01, respectively)). There were no significant differences in V 30 , V 40 , V 60 , D mean  or NTCP of small bowel PRV.    Conclusions  FDG-PET-guided IMRT can facilitate focal dose-escalation to regions with SUV above 2.0 for postoperative local recurrent rectal cancer.

bmc cancer

Focal dose escalation using FDG-PET-guided intensity-modulated radiation therapy boost for postoperative local recurrent rectal cancer: a planning study with comparison of DVH and NTCP