We previously published a review on the role of PET/CT in radiotherapy planning in Seminars in Nuclear Medicine.1 Herein we recapitulate on this issue, providing recent updates.

Radiotherapy plays a crucial role in cancer treatment, with more than 50% of cancer patients receiving it at some point during their care. It can be utilized as a standalone therapy or in combination with surgery and systemic treatments such as chemotherapy, tyrosine kinase inhibitors, and immune checkpoint inhibitors.2,3

The success of radiotherapy is primarily driven by advancements in combination treatment strategies, such as chemo-radio-immunotherapy for advanced nonsmall cell lung cancer (NSCLC) and small cell lung cancer (SCLC).4 Additionally, technological innovations have transformed the delivery of radiotherapy, including intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), stereotactic body radiation therapy (SBRT), and online adaptive MR-guided radiotherapy (oMRgRT), which are either becoming standard practices or being rapidly integrated into clinical workflows.5,6

Positron emission tomography (PET) is increasingly used in advanced cancer evaluation. PET provides molecular-level insights beyond standard imaging, enabling visualization and quantification of essential tumor characteristics, such as glucose metabolism and target receptor expression.7

The glucose analog [18F]FDG (18F-fluorodeoxyglucose) is the most widely utilized among the available PET radioligands. In lung cancer patients, [18F]FDG PET is essential for accurate staging and assessing treatment response and is recommended for delineating target volumes before thoracic irradiation.8

This review article emphasizes the importance of radiotherapy in managing lung cancer patients, highlighting the role of standard morphological imaging for staging and planning. Additionally, it explores the integration of PET-based radiotherapy planning and examines recent methodological and technological advancements that aim to enhance precision and outcomes in lung cancer radiotherapy.