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Open Access 01-12-2009 | Research

Integrated-boost IMRT or 3-D-CRT using FET-PET based auto-contoured target volume delineation for glioblastoma multiforme - a dosimetric comparison

Authors: Marc D Piroth, Michael Pinkawa, Richard Holy, Gabriele Stoffels, Cengiz Demirel, Charbel Attieh, Hans J Kaiser, Karl J Langen, Michael J Eble

Published in: Radiation Oncology | Issue 1/2009

Abstract

Background

Biological brain tumor imaging using O-(2-[¹⁸F]fluoroethyl)-L-tyrosine (FET)-PET combined with inverse treatment planning for locally restricted dose escalation in patients with glioblastoma multiforme seems to be a promising approach.

The aim of this study was to compare inverse with forward treatment planning for an integrated boost dose application in patients suffering from a glioblastoma multiforme, while biological target volumes are based on FET-PET and MRI data sets.

Methods

In 16 glioblastoma patients an intensity-modulated radiotherapy technique comprising an integrated boost (IB-IMRT) and a 3-dimensional conventional radiotherapy (3D-CRT) technique were generated for dosimetric comparison. FET-PET, MRI and treatment planning CT (P-CT) were co-registrated. The integrated boost volume (PTV1) was auto-contoured using a cut-off tumor-to-brain ratio (TBR) of ≥ 1.6 from FET-PET. PTV2 delineation was MRI-based. The total dose was prescribed to 72 and 60 Gy for PTV1 and PTV2, using daily fractions of 2.4 and 2 Gy.

Results

After auto-contouring of PTV1 a marked target shape complexity had an impact on the dosimetric outcome. Patients with 3-4 PTV1 subvolumes vs. a single volume revealed a significant decrease in mean dose (67.7 vs. 70.6 Gy). From convex to complex shaped PTV1 mean doses decreased from 71.3 Gy to 67.7 Gy. The homogeneity and conformity for PTV1 and PTV2 was significantly improved with IB-IMRT. With the use of IB-IMRT the minimum dose within PTV1 (61.1 vs. 57.4 Gy) and PTV2 (51.4 vs. 40.9 Gy) increased significantly, and the mean EUD for PTV2 was improved (59.9 vs. 55.3 Gy, p < 0.01). The EUD for PTV1 was only slightly improved (68.3 vs. 67.3 Gy). The EUD for the brain was equal with both planning techniques.

Conclusion

In the presented planning study the integrated boost concept based on inversely planned IB-IMRT is feasible. The FET-PET-based automatically contoured PTV1 can lead to very complex geometric configurations, limiting the achievable mean dose in the boost volume. With IB-IMRT a better homogeneity and conformity, compared to 3D-CRT, could be achieved.

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Stupp R, Mason WP, Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al.: Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005,352(10):987-996. 10.1056/NEJMoa043330CrossRefPubMed

Stupp R, Hegi ME, Mason WP, Bent MJ, Taphoorn MJ, Janzer RC, et al.: Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009,10(5):459-466. 10.1016/S1470-2045(09)70025-7CrossRefPubMed

Bleehen NM, Stenning SP: A Medical Research Council trial of two radiotherapy doses in the treatment of grades 3 and 4 astrocytoma. The Medical Research Council Brain Tumour Working Party. Br J Cancer 1991,64(4):769-774.PubMedCentralCrossRefPubMed

Walker MD, Strike TA, Sheline GE: An analysis of dose-effect relationship in the radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys 1979,5(10):1725-1731.CrossRefPubMed

Taghian A, Ramsay J, Allalunis-Turner J, Budach W, Gioioso D, Pardo F, et al.: Intrinsic radiation sensitivity may not be the major determinant of the poor clinical outcome of glioblastoma multiforme. Int J Radiat Oncol Biol Phys 1993,25(2):243-249.CrossRefPubMed

Taghian A, DuBois W, Budach W, Baumann M, Freeman J, Suit H: In vivo radiation sensitivity of glioblastoma multiforme. Int J Radiat Oncol Biol Phys 1995,32(1):99-104.CrossRefPubMed

Taghian A, Suit H, Baumann M: In vitro and in vivo radiation sensitivity of glioblastoma multiforme: correction. Int J Radiat Oncol Biol Phys 1996,35(5):1124-1125.CrossRefPubMed

Taghian A: In vitro and in vivo radiation sensitivity of glioblastoma multiforme: correction. Int J Radiat Oncol Biol Phys 1998,42(2):464.CrossRefPubMed

Loeffler JS, Alexander E III, Shea WM, Wen PY, Fine HA, Kooy HM, et al.: Radiosurgery as part of the initial management of patients with malignant gliomas. J Clin Oncol 1992,10(9):1379-1385.PubMed

10.

Sarkaria JN, Mehta MP, Loeffler JS, Buatti JM, Chappell RJ, Levin AB, et al.: Radiosurgery in the initial management of malignant gliomas: survival comparison with the RTOG recursive partitioning analysis. Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 1995,32(4):931-941.CrossRefPubMed

11.

Souhami L, Seiferheld W, Brachman D, Podgorsak EB, Werner-Wasik M, Lustig R, et al.: Randomized comparison of stereotactic radiosurgery followed by conventional radiotherapy with carmustine to conventional radiotherapy with carmustine for patients with glioblastoma multiforme: report of Radiation Therapy Oncology Group 93-05 protocol. Int J Radiat Oncol Biol Phys 2004,60(3):853-860.CrossRefPubMed

12.

Grosu AL, Weber WA, Franz M, Stark S, Piert M, Thamm R, et al.: Reirradiation of recurrent high-grade gliomas using amino acid PET (SPECT)/CT/MRI image fusion to determine gross tumor volume for stereotactic fractionated radiotherapy. Int J Radiat Oncol Biol Phys 2005,63(2):511-519.CrossRefPubMed

13.

Lee IH, Piert M, Gomez-Hassan D, Junck L, Rogers L, Hayman J, et al.: Association of 11C-methionine PET uptake with site of failure after concurrent temozolomide and radiation for primary glioblastoma multiforme. Int J Radiat Oncol Biol Phys 2009,73(2):479-485.PubMedCentralCrossRefPubMed

14.

Ogawa T, Shishido F, Kanno I, Inugami A, Fujita H, Murakami M, et al.: Cerebral glioma: evaluation with methionine PET. Radiology 1993,186(1):45-53.CrossRefPubMed

15.

Pauleit D, Floeth F, Hamacher K, Riemenschneider MJ, Reifenberger G, Muller HW, et al.: O-(2-[18F]fluoroethyl)-L-tyrosine PET combined with MRI improves the diagnostic assessment of cerebral gliomas. Brain 2005,128(Pt 3):678-687. 10.1093/brain/awh399CrossRefPubMed

16.

Rachinger W, Goetz C, Popperl G, Gildehaus FJ, Kreth FW, Holtmannspotter M, et al.: Positron emission tomography with O-(2-[18F]fluoroethyl)-l-tyrosine versus magnetic resonance imaging in the diagnosis of recurrent gliomas. Neurosurgery 2005,57(3):505-511. 10.1227/01.NEU.0000171642.49553.B0CrossRefPubMed

17.

Fuss M, Salter BJ, Rassiah P, Cheek D, Cavanaugh SX, Herman TS: Repositioning accuracy of a commercially available double-vacuum whole body immobilization system for stereotactic body radiation therapy. Technol Cancer Res Treat 2004,3(1):59-67.CrossRefPubMed

18.

Langen KJ, Hamacher K, Weckesser M, Floeth F, Stoffels G, Bauer D, et al.: O-(2-[18F]fluoroethyl)-L-tyrosine: uptake mechanisms and clinical applications. Nucl Med Biol 2006,33(3):287-294. 10.1016/j.nucmedbio.2006.01.002CrossRefPubMed

19.

Roesch P, Netsch T, McNutt T, Shoenbill J, Roost P: Syntegra - Automated image registration algorithms. Philips White Paper 2003.

20.

Weckesser M, Griessmeier M, Schmidt D, Sonnenberg F, Ziemons K, Kemna L, et al.: Iodine-123 alpha-methyl tyrosine single-photon emission tomography of cerebral gliomas: standardised evaluation of tumour uptake and extent. Eur J Nucl Med 1998,25(2):150-156. 10.1007/s002590050208CrossRefPubMed

21.

Popperl G, Gotz C, Rachinger W, Gildehaus FJ, Tonn JC, Tatsch K: Value of O-(2-[18F]fluoroethyl)- L-tyrosine PET for the diagnosis of recurrent glioma. Eur J Nucl Med Mol Imaging 2004,31(11):1464-1470. 10.1007/s00259-004-1590-1CrossRefPubMed

22.

Weckesser M, Langen KJ, Rickert CH, Kloska S, Straeter R, Hamacher K, et al.: O-(2-[18F]fluorethyl)-L-tyrosine PET in the clinical evaluation of primary brain tumours. Eur J Nucl Med Mol Imaging 2005,32(4):422-429. 10.1007/s00259-004-1705-8CrossRefPubMed

23.

Prescribing, Recording and Reporting Photon Beam Therapy Journal of the International Commission on Radiation Units and Measurements 1993. Report 50

24.

Prescribing, Recording and Reporting Photon Beam Therapy (Supplement to ICRU 50 Report) Journal of the International Commission on Radiation Units and Measurements 1999. Report 62

25.

Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et al.: Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991,21(1):109-122.CrossRefPubMed

26.

Tome WA, Meeks SL, Buatti JM, Bova FJ, Friedman WA, Li Z: A high-precision system for conformal intracranial radiotherapy. Int J Radiat Oncol Biol Phys 2000,47(4):1137-1143.CrossRefPubMed

27.

Paddick I: A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg 2000, 3: 219-222.

28.

Niemierko A: Reporting and analyzing dose distributions: a concept of equivalent uniform dose. Med Phys 1997,24(1):103-110. 10.1118/1.598063CrossRefPubMed

29.

Niemierko A: Radiobiological models of tissue response to radiation in treatment planning systems. Tumori 1998,84(2):140-143.PubMed

30.

RaySearch Laboratories AB SS: Biological optimization using the equivalent uniform dose (EUD) in Pinnacle³. RaySearch White Paper 2003. WP-EUD rev.1, 0310

31.

Burman C, Kutcher GJ, Emami B, Goitein M: Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys 1991,21(1):123-135.CrossRefPubMed

32.

Luxton G, Keall PJ, King CR: A new formula for normal tissue complication probability (NTCP) as a function of equivalent uniform dose (EUD). Phys Med Biol 2008,53(1):23-36. 10.1088/0031-9155/53/1/002CrossRefPubMed

33.

Semenenko VA, Reitz B, Day E, Qi XS, Miften M, Li XA: Evaluation of a commercial biologically based IMRT treatment planning system. Med Phys 2008,35(12):5851-5860. 10.1118/1.3013556CrossRefPubMed

34.

Hochberg FH, Pruitt A: Assumptions in the radiotherapy of glioblastoma. Neurology 1980,30(9):907-911.CrossRefPubMed

35.

Jansen EP, Dewit LG, van HM, Bartelink H: Target volumes in radiotherapy for high-grade malignant glioma of the brain. Radiother Oncol 2000,56(2):151-156. 10.1016/S0167-8140(00)00216-4CrossRefPubMed

36.

Shrieve DC, Alexander E III, Black PM, Wen PY, Fine HA, Kooy HM, et al.: Treatment of patients with primary glioblastoma multiforme with standard postoperative radiotherapy and radiosurgical boost: prognostic factors and long-term outcome. J Neurosurg 1999,90(1):72-77. 10.3171/jns.1999.90.1.0072CrossRefPubMed

37.

Tanaka M, Ino Y, Nakagawa K, Tago M, Todo T: High-dose conformal radiotherapy for supratentorial malignant glioma: a historical comparison. Lancet Oncol 2005,6(12):953-960. 10.1016/S1470-2045(05)70395-8CrossRefPubMed

38.

Irish WD, Macdonald DR, Cairncross JG: Measuring bias in uncontrolled brain tumor trials--to randomize or not to randomize? Can J Neurol Sci 1997,24(4):307-312.PubMed

39.

Litofsky NS, Bauer AM, Kasper RS, Sullivan CM, Dabbous OH: Image-guided resection of high-grade glioma: patient selection factors and outcome. Neurosurg Focus 2006,20(4):E16. 10.3171/foc.2006.20.4.10CrossRefPubMed

40.

Winger MJ, Macdonald DR, Schold SC Jr, Cairncross JG: Selection bias in clinical trials of anaplastic glioma. Ann Neurol 1989,26(4):531-534. 10.1002/ana.410260406CrossRefPubMed

41.

Tsien C, Moughan J, Michalski JM, Gilbert MR, Purdy J, Simpson J, et al.: Phase I three-dimensional conformal radiation dose escalation study in newly diagnosed glioblastoma: Radiation Therapy Oncology Group Trial 98-03. Int J Radiat Oncol Biol Phys 2009,73(3):699-708.PubMedCentralCrossRefPubMed

42.

Laperriere NJ, Leung PM, McKenzie S, Milosevic M, Wong S, Glen J, et al.: Randomized study of brachytherapy in the initial management of patients with malignant astrocytoma. Int J Radiat Oncol Biol Phys 1998,41(5):1005-1011.CrossRefPubMed

43.

Selker RG, Shapiro WR, Burger P, Blackwood MS, Arena VC, Gilder JC, et al.: The Brain Tumor Cooperative Group NIH Trial 87-01: a randomized comparison of surgery, external radiotherapy, and carmustine versus surgery, interstitial radiotherapy boost, external radiation therapy, and carmustine. Neurosurgery 2002,51(2):343-355. 10.1097/00006123-200208000-00009PubMed

44.

Rickhey M, Koelbl O, Eilles C, Bogner L: A biologically adapted dose-escalation approach, demonstrated for 18F-FET-PET in brain tumors. Strahlenther Onkol 2008,184(10):536-542. 10.1007/s00066-008-1883-6CrossRefPubMed

45.

Vees H, Senthamizhchelvan S, Miralbell R, Weber DC, Ratib O, Zaidi H: Assessment of various strategies for 18F-FET PET-guided delineation of target volumes in high-grade glioma patients. Eur J Nucl Med Mol Imaging 2009,36(2):182-193. 10.1007/s00259-008-0943-6CrossRefPubMed

46.

Weber DC, Zilli T, Buchegger F, Casanova N, Haller G, Rouzaud M, et al.: [(18)F]Fluoroethyltyrosine- positron emission tomography-guided radiotherapy for high-grade glioma. Radiat Oncol 2008, 3: 44. 10.1186/1748-717X-3-44PubMedCentralCrossRefPubMed

47.

Weltens C, Menten J, Feron M, Bellon E, Demaerel P, Maes F, et al.: Interobserver variations in gross tumor volume delineation of brain tumors on computed tomography and impact of magnetic resonance imaging. Radiother Oncol 2001,60(1):49-59. 10.1016/S0167-8140(01)00371-1CrossRefPubMed

48.

Cozzi L, Fogliata A, Bolsi A, Nicolini G, Bernier J: Three-dimensional conformal vs. intensity-modulated radiotherapy in head-and-neck cancer patients: comparative analysis of dosimetric and technical parameters. Int J Radiat Oncol Biol Phys 2004,58(2):617-624.CrossRefPubMed

49.

Grills IS, Yan D, Martinez AA, Vicini FA, Wong JW, Kestin LL: Potential for reduced toxicity and dose escalation in the treatment of inoperable non-small-cell lung cancer: a comparison of intensity-modulated radiation therapy (IMRT), 3D conformal radiation, and elective nodal irradiation. Int J Radiat Oncol Biol Phys 2003,57(3):875-890.CrossRefPubMed

50.

Selvaraj RN, Beriwal S, Pourarian RJ, Lalonde RJ, Chen A, Mehta K, et al.: Clinical implementation of tangential field intensity modulated radiation therapy (IMRT) using sliding window technique and dosimetric comparison with 3D conformal therapy (3DCRT) in breast cancer. Med Dosim 2007,32(4):299-304. 10.1016/j.meddos.2007.03.001CrossRefPubMed

51.

Pinkawa M, Siluschek J, Gagel B, Piroth MD, Demirel C, Asadpour B, et al.: Postoperative radiotherapy for prostate cancer: evaluation of target motion and treatment techniques (intensity-modulated versus conformal radiotherapy). Strahlenther Onkol 2007,183(1):23-29. 10.1007/s00066-007-1588-2CrossRefPubMed

52.

Pinkawa M, Attieh C, Piroth MD, Holy R, Nussen S, Klotz J, et al.: Dose-escalation using intensity-modulated radiotherapy for prostate cancer--evaluation of the dose distribution with and without 18F-choline PET-CT detected simultaneous integrated boost. Radiother Oncol 2009,93(2):213-219. 10.1016/j.radonc.2009.07.014CrossRefPubMed

53.

Pirzkall A, Carol M, Lohr F, Hoss A, Wannenmacher M, Debus J: Comparison of intensity-modulated radiotherapy with conventional conformal radiotherapy for complex-shaped tumors. Int J Radiat Oncol Biol Phys 2000,48(5):1371-1380.CrossRefPubMed

54.

Chan MF, Schupak K, Burman C, Chui CS, Ling CC: Comparison of intensity-modulated radiotherapy with three-dimensional conformal radiation therapy planning for glioblastoma multiforme. Med Dosim 2003,28(4):261-265. 10.1016/j.meddos.2003.08.004CrossRefPubMed

55.

Narayana A, Yamada J, Berry S, Shah P, Hunt M, Gutin PH, et al.: Intensity-modulated radiotherapy in high-grade gliomas: clinical and dosimetric results. Int J Radiat Oncol Biol Phys 2006,64(3):892-897.CrossRefPubMed

56.

MacDonald SM, Ahmad S, Kachris S, Vogds BJ, DeRouen M, Gittleman AE, et al.: Intensity modulated radiation therapy versus three-dimensional conformal radiation therapy for the treatment of high grade glioma: a dosimetric comparison. J Appl Clin Med Phys 2007,8(2):47-60.PubMed

57.

Hermanto U, Frija EK, Lii MJ, Chang EL, Mahajan A, Woo SY: Intensity-modulated radiotherapy (IMRT) and conventional three-dimensional conformal radiotherapy for high-grade gliomas: does IMRT increase the integral dose to normal brain? Int J Radiat Oncol Biol Phys 2007,67(4):1135-1144.CrossRefPubMed

58.

Thilmann C, Zabel A, Grosser KH, Hoess A, Wannenmacher M, Debus J: Intensity-modulated radiotherapy with an integrated boost to the macroscopic tumor volume in the treatment of high-grade gliomas. Int J Cancer 2001,96(6):341-349. 10.1002/ijc.1042CrossRefPubMed

59.

Chang EL, Akyurek S, Avalos T, Rebueno N, Spicer C, Garcia J, et al.: Evaluation of peritumoral edema in the delineation of radiotherapy clinical target volumes for glioblastoma. Int J Radiat Oncol Biol Phys 2007,68(1):144-150.CrossRefPubMed

60.

Tome WA, Fowler JF: On cold spots in tumor subvolumes. Med Phys 2002,29(7):1590-1598. 10.1118/1.1485060CrossRefPubMed

61.

Qi XS, Schultz CJ, Li XA: An estimation of radiobiologic parameters from clinical outcomes for radiation treatment planning of brain tumor. Int J Radiat Oncol Biol Phys 2006,64(5):1570-1580.CrossRefPubMed

62.

Thieke C, Bortfeld T, Niemierko A, Nill S: From physical dose constraints to equivalent uniform dose constraints in inverse radiotherapy planning. Med Phys 2003,30(9):2332-2339. 10.1118/1.1598852CrossRefPubMed

Title: Integrated-boost IMRT or 3-D-CRT using FET-PET based auto-contoured target volume delineation for glioblastoma multiforme - a dosimetric comparison
Authors: Marc D Piroth
Michael Pinkawa
Richard Holy
Gabriele Stoffels
Cengiz Demirel
Charbel Attieh
Hans J Kaiser
Karl J Langen
Michael J Eble
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2009
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-4-57

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Integrated-boost IMRT or 3-D-CRT using FET-PET based auto-contoured target volume delineation for glioblastoma multiforme - a dosimetric comparison

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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