Imagerie TEP-FDG et volumes-cibles pour la radiothérapie des cancers bronchiques

Determining target volumes is a major preoccupation of radiotherapists. The need to deliver high doses aiming for local control in non-small-cell lung cancers, while preventing serious lesions in at-risk adjacent organs (notably the lungs), makes it indispensable to precisely localize the primary tumor and the invaded lymph nodes. CT imaging is insufficient to reduce the mediastinal target volume. 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) improves the quality of the metastasis staging, aids in determining the target volume (notably in mediastinal lymph nodes), and provides information for prognosis. Despite technical problems (image resolution, multimodal superimposition of images, criteria to delineate the hypermetabolic zones), FDG-PET has become vital. Its role in adapting radiation doses should be evaluated, however, by large-scale prospective clinical trials.