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WE-FG-202-04: Decomposition of FDG-PET Based Differential Uptake Volume Histograms in Rectal Cancer Patients.

PURPOSE
The goal of this study is to test the possible use of the analytical decomposition of differential uptake volume histograms (dUVHs) obtained from FDG-PET/CT data to isolate sub-volumes within a tumor known as biological target volumes (BTVs).


METHODS
A retrospective study was conducted on a cohort of 20 histo-pathologically confirmed rectal adenocarcinoma patients having PET/CT scans for staging. All patients (T3N0) underwent pre-operative endorectal brachytherapy. After surgery, patients were restaged: 10 patients were T0N0 and 10 were restaged as remaining T3N0. The extent of the disease was sampled in order to create dUVHs; subsequently decomposed into the fewest number of analytical Gaussian functions.


RESULTS
With the assumption that each function fit corresponded to a single sub-volume within the tumor, six sub-volumes were found to consistently emerge. The first two sub-volumes were influenced by contouring and were not considered in the analysis. For the T3N0 population, abundances for volumes V3-V6 were 63.6%±11.3%, 25.7%±8.4%, 6.1%±4.9%, and 4.7%±2.6%. For the T0N0 population, they were 50.2%±6.8%, 33.4%±4.3%, 11.8%±7.6%, and 4.7%±2.4%. The two populations were compared using two tailed T-tests: volumes 3 and 4 were statistically different with p values of 0.021 and 0.056 respectively. V6 was located at 8.63 ± 2.2 for T0N0 and 6.14 ± 0.78 for T3N0 group (p=0.016).


CONCLUSION
We described a method for dUVH decomposition using FDG-PET images of rectal adenocarcinoma patients that subsequently went for pre-operative brachytherapy. In addition to extracting different sub-volumes corresponding to different FDG uptake levels, we observed different abundances of two sub-volumes as well as positions of the maximum uptake between the two patient groups. In addition to opening the door to further investigation into underlying physiological phenotypes of segmented subvolumes and their use for biological radiotherapy treatment planning, this method may also provide parameters that could correlate to clinical outcomes in radiotherapy patients.