Is 68 Ga-DOTA-FAPI a new arrow in the quiver of dose painting in radiation dose planning in head and neck cancers?
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EDITORIAL
Is 68Ga-DOTA-FAPI a new arrow in the quiver of dose painting in radiation dose planning in head and neck cancers? Patrick Conen 1,2 & Felix M. Mottaghy 1,2,3
# The Author(s) 2020
The majority of head and neck cancers is of epithelial origin with squamous cell carcinoma being the most common one [1]. Radiotherapy or combined radiochemotherapy is the main therapeutic option implemented as adjuvant or neoadjuvant approach. In recent years, sophisticated radiation dose planning using morphological and functional imaging modalities and the combination has evolved and has been proposed as a base for individualized radiotherapy planning [2]. However, until now, the clinical standard diagnostic tools to calculate the gross tumour volume (GTV) are computed tomography (CT) and magnetic resonance tomography imaging (MRI) [3]. While the radiotherapy regimens have been developed over the past decades from volumetric intensity-modulated arc therapy (VMAT) over intensity-modulated radiotherapy (IMRT) to possibly intensity-modulated proton therapy (IMPT) [4], there is an urgent need to specify the planning target volume of the tumour. The aim of improving the precision in tumour delineation of head and neck cancers is the reduction of the tumour recurrence rate and the minimization of side effects of the radiotherapy by sparing peritumoural normal tissue. Biological dose adaptation radiotherapy based on molecular and structural imaging has become an important field of research in the recent years [5, 6]. The standard tracer in oncology fluorine labelled fluordeoxyglucose ([18F]-FDG) has been evaluated with respect to the potential to deliver a valid prognosis based on This article is part of the Topical Collection on Oncology Head and Neck * Felix M. Mottaghy [email protected] 1
Department of Nuclear Medicine, University Hospital RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
2
Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany
3
Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), P. Debeylaan 25, 6229 HX Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
the initial or interim PET/CT scans in a large number of studies [7]. These studies demonstrated a high predictive value of post therapy FDG uptake [8]. Radiotherapy planning studies using [18F]-FDG-PET/CT or [18F]-FDG-PET/MRI resulted in an improved detection of the gross tumour volume (GTV) in comparison with structural imaging (either CT or MRI) alone [9–11]. On the other hand, the limitations of [18F]-FDG-PET have to be considered when it comes to the specificity of the uptake since several structures in the neck show physiological or inflammation-related uptake of glucose influencing the correct contouring of the tumour significantly [9]. Another aspect that has to be taken into account is the value of interim imaging during treatment as an early treatment evaluation [12]. Also, in this setting, the lacking specificity of FDG wi
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