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Background  To validate a gradient-based segmentation method for gross tumor volume(GTV) delineation on  8 F-fluorothymidine (FLT)positron emission tomography (PET)/ computer tomography (CT) in esophageal squamous cell cancer through pathologic specimen, in comparison with standardized uptake values (SUV) threshold-based methods and CT. The corresponding impact of this GTV delineation method on treatment planning was evaluated.    Methods and materials  Ten patients with esophageal squamous cell cancer were enrolled. Before radical surgery, all patients underwent FLT-PET/CT. GTVs were delineated by using four methods. GTV GRAD , GTV 1.4  and GTV 30%max  were segmented on FLT PET using a gradient-based method, a fixed threshold of 1.4 SUV and 30% of SUV max , respectively. GTV CT  was based on CT data alone. The maximum longitudinal tumor length of each segmented GTV was compared with the measured tumor length of the pathologic gross tumor length (L Path ). GTV GRAD , GTV 1.4  and GTV 30%max  were compared with GTV CT  by overlap index. Two radiotherapy plannings (plan GRAD ) and (plan CT ) were designed for each patient based on GTV GRAD  and GTV CT . The dose-volume parameters for target volume and normal tissues, CI and HI of plan GRAD  and plan CT  were compared.    Results  The mean ± standard deviation of L Path  was 6.47 ± 2.70 cm. The mean ± standard deviation of L GRAD ,L 1.4 , L 30%max  and L CT  were 6.22 ± 2.61, 6.23 ± 2.80, 5.95 ± 2.50,7.17 ± 2.28 cm, respectively. The Pearson correlation coefficients between L Path  and each segmentation method were 0.989, 0.920, 0.920 and 0.862, respectively. The overlap indices of GTV GRAD , GTV 1.4 , GTV 30%max  when compared with GTV CT  were 0.75 ± 0.12, 0.71 ± 0.12, 0.57 ± 0.10, respectively. The V 5 , V 10 , V 20 , V 30  and mean dose of total-lung,V 30  and mean dose of heart of plan GRAD  were significantly lower than plan CT .    Conclusions  The gradient-based method provided the closest estimation of target length. The radiotherapy plannings based on the gradient-based segmentation method reduced the irradiated volume of lung, heart in comparison to CT.

Gradient-based delineation of the primary GTV on FLT PET in squamous cell cancer of the thoracic esophagus and impact on radiotherapy planning