{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T00:04:18Z","timestamp":1793837058666,"version":"4.6.1"},"reference-count":35,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Lung cancer is the leading cause of cancer-related mortality worldwide. Accurate radiotherapy (RT) planning alongside chemotherapy and immunotherapy is critical for improving treatment outcomes for inoperable non-metastatic cases. Conventional computed tomography (CT)-based planning may be inadequate for accurately identifying tumor margins and the location of nodal disease. We investigated whether 18F-labeled fluorodeoxyglucose positron emission tomography (18F-FDG PET-CT) imaging can assist in target volume delineation for primary, nodal, and metastatic disease in the RT planning and overall therapeutic planning of patients. Methods: In this single-center, prospective study, we recruited 34 patients with histologically confirmed locally advanced non-small-cell lung carcinoma (NSCLC). All patients underwent 18F-FDG PET-CT-based RT simulation. Two sequential RT plans were created by the same radiation oncologist: one based on CT alone and the other PET-CT. Planning target volumes (PTVs) and PET-CT-guided adjustments were analyzed to assess their impact. Standardized protocols for immobilization, imaging, target delineation, and dose prescription were applied. Results: A total of 34 patients (31 males and 3 females) were recruited in the study. 18F-FDG PET-CT detected distant metastases in 7\/34 (20.6%) patients, altering the overall therapeutic plan in 4\/34 (11.8%) and allowing radical RT in 3 of them who had oligometastatic disease (8.8%). It modified RT planning in 26\/34 (76.5%) patients and clarified malignancy in atelectatic areas. Nodal involvement was identified in 3\/34 patients (8.8%) and excluded in 3\/34 cases, avoiding unnecessary nodal irradiation. Additional involved nodes were revealed in 12\/34 (35.3%) patients, requiring dose escalation. Overall, changes to the tumor PTV were made in 23\/30 (76.6%) and to the nodal PTV in 19\/30 (63.3%) cases (p &lt; 0.0001). Primary tumor and nodal PTVs increased in 20\/34 (66.7%) and 13\/34 (43.3%), respectively. Conclusions: 18F-FDG PET-CT significantly improves RT planning by more precisely defining tumor and nodal volumes, identifying undetected lesions, and guiding dose adaptation. Larger long-term studies are required to confirm potential locoregional control and survival improvements.<\/jats:p>","DOI":"10.3390\/cancers17121969","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T03:53:12Z","timestamp":1749786792000},"page":"1969","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Benefits from 18F-FDG PET-CT-Based Radiotherapy Planning in Stage III Non-Small-Cell Lung Cancer: A Prospective Single-Center Study"],"prefix":"10.3390","volume":"17","author":[{"given":"Admir","family":"Mulita","sequence":"first","affiliation":[{"name":"Department of Radiotherapy\/Oncology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pipitsa","family":"Valsamaki","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1290-1802","authenticated-orcid":false,"given":"Eleni","family":"Bekou","sequence":"additional","affiliation":[{"name":"Medical Physics Laboratory, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavros","family":"Anevlavis","sequence":"additional","affiliation":[{"name":"Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7138-6671","authenticated-orcid":false,"given":"Christos","family":"Nanos","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy\/Oncology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Zisimopoulos","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Giatromanolaki","sequence":"additional","affiliation":[{"name":"Department of Pathology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2324-699X","authenticated-orcid":false,"given":"Michael I.","family":"Koukourakis","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy\/Oncology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"key":"ref_1","unstructured":"(2025, January 21). 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