Radiation Therapy Planning of Non-small Cell Lung Cancer based on PET/CT. (Diagnostic component)

Closed for proposals

Project Type

Coordinated Research Project

Project Code




Approved Date

13 November 2013


4 - Closed

Start Date

29 May 2014

Expected End Date

31 December 2018

Completed Date

3 May 2019

Participating Countries

Viet Nam


Non-small Cell Lung Cancer (NSCLC) is considered in many countries as a leading cause of cancer related morbidity and mortality. While curative radiation therapy can be performed on patients who are surgically inoperable, local control and overall survival rates have historically been low, possibly due to inappropriate selection of patients and uncertainties in target definition.  It is hoped that 18F-Fluorodeoxyglucose (18F-FDG) PET/CT based radiation therapy treatment planning (RTP) would enable appropriate selection of patients who would benefit from curative radiation therapy and improve Target Volume Definition (TVD), leading to better outcomes following curative radiation therapy. Aiming at standardising PET/CT based Radio Therapy Planning (RTP) and improving clinical outcomes for patients diagnosed with NSCLC, the IAEA Division of Human Health has initiated two Coordinated Research Projects (CRPs), E13042 and E33038, with one titled “Radiation Therapy Planning of Non-small cell lung cancer based on PET/CT“. These CRPs complement each other and will be conducted respectively by the Nuclear Medicine and Diagnostic Imaging Section (NMDI) and the Applied Radiation Biology and Radiotherapy Section (ARBR).While CRP E13042, conducted by NMDI, will focus on the diagnostic aspects of introducing 18F-FDG PET/CT for RTP including quality control, acquisition and processing protocols, and imaging analysis and interpretation; CRP E33038, conducted by ARBR, will concentrate on the PET/CT utilization for the TVD and on the clinical outcomes of such treatment approach. PET/CT for radiation therapy treatment planning will be introduced to patients with stage III A/B NSCLC in participating centres that are suitably equipped but unable to implement this technology properly. To achieve this goal CRP E13042 will be conducted in two phases; a preparatory phase to acquire and maintain competencies in PET/CT based RTP for NSCLC, followed by a prospective clinical trial to evaluate the effect of PET/CT based RTP in recruited patients. Research institutions willing to participate in these CRPs must have the required infrastructure and be able to nominate two chief scientific investigators, one from the nuclear medicine department to be involved in the diagnostic component of E13042 and the other from the radiation oncology department to work on the activities related to E33038.  


Determine the impact of PET/CT in RTP on 2-year overall survival rates for patients with stage III NSCLC receiving chemo-radiotherapy with curative intent.

Specific objectives

To improve the overall survival in patients with NSCLC by the use of PET/CT-based TVD for the purposes of RTP.

To improve the quality and reproducibility of PET/CT-based radiation therapy target volume definition in patients with NSCLC by means of a training intervention


During the CRP is was possible to achieve the expected results and prove the primary and secondary objectives.
In addition, some important milestones were achieved.

Milestone achieved:
EARL accreditation standardized PET/CT protocols and image quality of PET scans across all centres;
Accessibility to NEMA phantoms for PET/CT QA;
Change in clinical practice;
Adoption of new protocol;
Collaboration improved between RT and NM;
PET/CT became an important upfront technology, all stage III patients get PET/CT;
PET/CT in treatment position for all lung cancer patients;
More confidence is observed in treating patients more radically with CCRT, but also in target volume delineation;
Participating in PERTAIN opened eyes for more research;
Increased the awareness of other centres on FDG PET/CT applications;
Centres disseminate expertise learned from CRP training interventions through seminars and conferences;
Better patient selection for CCRT is achieved.


This CRP that included 9 research centres in 7 countries contributes to achieve the SDG goal 3.4, by 2013 reduce by 30% the premature mortality due to NCDs. Which is in line with the objective of programme 2.2. of Supporting MS to address their health needs related to the prevention, diagnosis and treatment using radiation medicine. In the case of the CRP E13042 (nuclear medicine component) that was conducted in parallel with the CRP E33038 (radiation oncology component) aimed at supporting the management of patients with NSCLC which is a highly prevalent cancer and to Improvement patient outcomes

CRP Publications


Peer review journal




Journal: Radiotherapy and Oncology 116 (2015) 27–34


Title: IAEA consensus report PET/CT imaging for target volume delineation in curative intent radiotherapy of non-small cell lung cancer: IAEA consensus report 2014.Authors: Tom Konert , Wouter Vogel, Michael P. MacManus, Ursula Nestle, José Belderbos, Vincent Grégoire, Daniela Thorwarth, Elena Fidarova, Diana Paez, Arturo Chiti, Gerard G. Hanna


Abstract presented at international conference




Presented at: ESTRO 2015


Title: Multiple training interventions significantly improve PET/CT based lung cancer radiotherapy target volume delineation following a standardized delineation protocol in an IAEA study.Authors: Tom Konert, Wouter Vogel, Michael P. MacManus, Sarah Everitt, Daniela Thorwarth, Jan Jakob Sonke, Diana Paez, Elena Fidarova, Gerard G. Hanna


Multiple training interventions significantly improve reproducibility of PET/CT-based lung cancer radiotherapy target volume delineation using an IAEA study protocol




Radiother Oncol. 2016 Oct;121(1):39-45.


Peer review journal


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