Abstract：
OBJECTIVE: Positron emission tomography (PET) imaging has been useful in delineating tumor volumes and allowing for improved radiation treatment. The field of PET-guided radiotherapy is rapidly growing and will have significant impact on radiotherapy delivery in the future. This narrative review provides an overview of the current state of PET-guided radiotherapy as well as the future directions of the field.
METHODS: For this narrative review, PubMed was searched for articles from 2010-2023. A total of 18 keywords or phrases were searched to provide an overview of PET-guided radiotherapy, radiotracers, the role of PET-guided radiotherapy in oligometastatic disease, and biology-guided radiotherapy (BgRT). The first 300 results for each keyword were searched and relevant articles were extracted. The references of these articles were also reviewed for relevant articles.
UNASSIGNED: In radiotherapy, 18F-2-fluoro-2-deoxy-D-glucose (F-FDG or FDG) is the major radiotracer for PET and when combined with computed tomography (CT) scan allows for anatomic visualization of metabolically active malignancy. Novel radiotracers are being explored to delineate certain cell types and numerous tumor metrics including metabolism, hypoxia, vascularity, and cellular proliferation. This molecular and functional imaging will provide improved tumor characterization. Through these radiotracers, radiation plans can employ dose painting by creating different dose levels based upon specific risk factors of the target volume. Additionally, biologic imaging during radiotherapy can allow for adaptation of the radiation plan based on response to treatment. Dose painting and adaptive radiotherapy should improve the therapeutic ratio through more selective dose delivery. The novel PET-linear accelerator hopes to combine these techniques and more by using radiotracers to deliver BgRT. The areas of radiotracer uptake will serve as fiducials to guide radiotherapy to themselves. This technique may prove promising in the growing area of oligometastatic radiation treatment.
CONCLUSIONS: Significant challenges exist for the future of PET-guided radiotherapy. However, with the advancements being made, PET imaging is set to change the delivery of radiotherapy.
METHODS: For this narrative review, PubMed was searched for articles from 2010-2023. A total of 18 keywords or phrases were searched to provide an overview of PET-guided radiotherapy, radiotracers, the role of PET-guided radiotherapy in oligometastatic disease, and biology-guided radiotherapy (BgRT). The first 300 results for each keyword were searched and relevant articles were extracted. The references of these articles were also reviewed for relevant articles.
UNASSIGNED: In radiotherapy, 18F-2-fluoro-2-deoxy-D-glucose (F-FDG or FDG) is the major radiotracer for PET and when combined with computed tomography (CT) scan allows for anatomic visualization of metabolically active malignancy. Novel radiotracers are being explored to delineate certain cell types and numerous tumor metrics including metabolism, hypoxia, vascularity, and cellular proliferation. This molecular and functional imaging will provide improved tumor characterization. Through these radiotracers, radiation plans can employ dose painting by creating different dose levels based upon specific risk factors of the target volume. Additionally, biologic imaging during radiotherapy can allow for adaptation of the radiation plan based on response to treatment. Dose painting and adaptive radiotherapy should improve the therapeutic ratio through more selective dose delivery. The novel PET-linear accelerator hopes to combine these techniques and more by using radiotracers to deliver BgRT. The areas of radiotracer uptake will serve as fiducials to guide radiotherapy to themselves. This technique may prove promising in the growing area of oligometastatic radiation treatment.
CONCLUSIONS: Significant challenges exist for the future of PET-guided radiotherapy. However, with the advancements being made, PET imaging is set to change the delivery of radiotherapy.
摘要：
目的：正电子发射断层扫描（PET）成像可用于描绘肿瘤体积并改善放射治疗。PET引导放射治疗领域正在迅速发展，未来将对放射治疗产生重大影响。这篇叙述性综述概述了PET引导放射治疗的现状以及该领域的未来方向。
方法：对于这篇叙述性综述，搜索了PubMed2010-2023年的文章。共搜索了18个关键词或短语，以提供PET引导放射治疗的概述，放射性示踪剂,PET引导放疗在寡转移疾病中的作用，和生物引导放射治疗（BgRT）。搜索每个关键词的前300个结果，并提取相关文章。这些文章的参考文献也针对相关文章进行了审查。
■在放射治疗中，18F-2-氟-2-脱氧-D-葡萄糖（F-FDG或FDG）是PET的主要放射性示踪剂，当与计算机断层扫描（CT）扫描结合使用时，可以对代谢活跃的恶性肿瘤进行解剖可视化。正在探索新的放射性示踪剂来描绘某些细胞类型和许多肿瘤指标，包括新陈代谢。缺氧,血管，和细胞增殖。这种分子和功能成像将提供改进的肿瘤表征。通过这些放射性示踪剂，辐射计划可以通过基于目标体积的特定风险因素创建不同的剂量水平来采用剂量绘画。此外,放射治疗期间的生物成像可以允许根据对治疗的反应来调整放射计划。剂量涂漆和适应性放疗应通过更多选择性剂量递送来提高治疗比例。新型PET-直线加速器希望通过使用放射性示踪剂递送BgRT来结合这些技术和更多技术。放射性示踪剂摄取的区域将用作基准以将放射治疗引导到自身。该技术在寡转移放射治疗的生长领域可能被证明是有前途的。
结论：PET引导放射治疗的未来存在重大挑战。然而,随着进步，PET成像被设置为改变放射治疗的递送。
方法：对于这篇叙述性综述，搜索了PubMed2010-2023年的文章。共搜索了18个关键词或短语，以提供PET引导放射治疗的概述，放射性示踪剂,PET引导放疗在寡转移疾病中的作用，和生物引导放射治疗（BgRT）。搜索每个关键词的前300个结果，并提取相关文章。这些文章的参考文献也针对相关文章进行了审查。
■在放射治疗中，18F-2-氟-2-脱氧-D-葡萄糖（F-FDG或FDG）是PET的主要放射性示踪剂，当与计算机断层扫描（CT）扫描结合使用时，可以对代谢活跃的恶性肿瘤进行解剖可视化。正在探索新的放射性示踪剂来描绘某些细胞类型和许多肿瘤指标，包括新陈代谢。缺氧,血管，和细胞增殖。这种分子和功能成像将提供改进的肿瘤表征。通过这些放射性示踪剂，辐射计划可以通过基于目标体积的特定风险因素创建不同的剂量水平来采用剂量绘画。此外,放射治疗期间的生物成像可以允许根据对治疗的反应来调整放射计划。剂量涂漆和适应性放疗应通过更多选择性剂量递送来提高治疗比例。新型PET-直线加速器希望通过使用放射性示踪剂递送BgRT来结合这些技术和更多技术。放射性示踪剂摄取的区域将用作基准以将放射治疗引导到自身。该技术在寡转移放射治疗的生长领域可能被证明是有前途的。
结论：PET引导放射治疗的未来存在重大挑战。然而,随着进步，PET成像被设置为改变放射治疗的递送。
