The application of PET in radiation treatment planning for head and neck cancer

FDG-PET imaging is being used more frequently by radiation oncologists for radiation treatment planning. PET is a powerful tool that provides metabolic/biologic data that can aid the oncologist in staging, treatment planning, and patient management. New gradient and adaptive threshold algorithms appear promising with regard to segmentation, and may reduce variability among radiation oncologists. We may find that the optimal segmentation method may vary according to subsite (eg, glottis, base of tongue). Studies in dose escalation to PET volumes will hopefully lead to improved local control of tumor, although randomized trials comparing dose escalation to conventional IMRT are needed. Finally, advances in PET and CT technology will hopefully lead to continued improvements in resolution, and new radiotracers will enable us to better refine the specific metabolic process in tumors for target delineation.