The Evolving Role of Molecular Imaging in Non–Small Cell Lung Cancer Radiotherapy

Molecular imaging with positron emission tomography (PET) has dramatically changed the management of patients with lung cancer who are treated with radiotherapy. Uptake of the most widely used PET radiopharmaceutical18 F-fluorodeoxyglucose identifies lung nodules or intrathoracic lymph nodes as like...

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Bibliographic Details
Published in:Seminars in radiation oncology 2015-04, Vol.25 (2), p.133-142
Main Authors: MacManus, Michael, MD, FRANZCR, Everitt, Sarah, PhD, Hicks, Rodney J., MD, FRACP
Format: Article
Language:English
Subjects:
Carcinoma, Non-Small-Cell Lung - diagnostic imaging
Carcinoma, Non-Small-Cell Lung - pathology
Carcinoma, Non-Small-Cell Lung - radiotherapy
Fluorodeoxyglucose F18
Hematology, Oncology and Palliative Medicine
Humans
Lung Neoplasms - diagnostic imaging
Lung Neoplasms - pathology
Lung Neoplasms - radiotherapy
Molecular Imaging - methods
Multimodal Imaging
Positron-Emission Tomography - methods
Radiology
Radiopharmaceuticals
Tomography, X-Ray Computed
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Summary:Molecular imaging with positron emission tomography (PET) has dramatically changed the management of patients with lung cancer who are treated with radiotherapy. Uptake of the most widely used PET radiopharmaceutical18 F-fluorodeoxyglucose identifies lung nodules or intrathoracic lymph nodes as likely to be malignant and frequently identifies previously unsuspected sites of malignant disease outside the thorax. Patients with non–small cell lung cancer, especially those with apparently more advanced locoregional disease to start with, are often upstaged, and this has a profound effect on their subsequent management. Better patient selection, primarily by excluding patients with PET-detected advanced disease, and better targeting of radiotherapy to avoid geographic miss have contributed significantly to improvements in outcome in recent series of patients treated with definitive chemoradiation. Advances in motion management with 4-dimensional PET/computed tomography and research into sequential imaging during treatment to permit response-adapted therapy hold promise for further improvements in treatment outcomes. Research involving novel PET tracers that can characterize biological properties of tumors, such as proliferation or hypoxia, may help develop more personalized approaches to patient management in the future.
ISSN:1053-4296
1532-9461
DOI:10.1016/j.semradonc.2014.12.001