Introduction: In patients suitable for radical chemoradiotherapy for lung cancer, 18F-FDGPET/
CT is a proposed management to improve the accuracy of high dose radiotherapy. However, there
is a high rate of locoregional failure in patients with locally advanced non-small cell lung cancer
(NSCLC), probably due to the fact that standard dosing may not be effective in all patients. The aim of
the present review was to address some criticisms associated with the radiotherapy image-guided in
Materials and Methods: A systematic literature search was conducted. Only published articles that met
the following criteria were included: articles, only original papers, radiopharmaceutical ([18F]FDG and
any tracer other than [18F]FDG), target, only specific for lung cancer radiotherapy planning, and experimental
design (eventually “in vitro” studies were excluded). Peer-reviewed indexed journals, regardless
of publication status (published, ahead of print, in press, etc.) were included. Reviews, case
reports, abstracts, editorials, poster presentations, and publications in languages other than English
were excluded. The decision to include or exclude an article was made by consensus and any disagreement
was resolved through discussion.
Results: Hundred eligible full-text articles were assessed. Diverse information is now available in the
literature about the role of FDG and new alternative radiopharmaceuticals for the planning of radiotherapy
in NSCLC. In particular, the role of alternative technologies for the segmentation of FDG uptake
is essential, although indeterminate for RT planning. The pros and cons of the available techniques
have been extensively reported.
Conclusion: PET/CT has a central place in the planning of radiotherapy for lung cancer and, in particular,
for NSCLC assuming a substantial role in the delineation of tumor volume. The development of
new radiopharmaceuticals can help overcome the problems related to the disadvantage of FDG to accumulate
also in activated inflammatory cells, thus improving tumor characterization and providing
new prognostic biomarkers.