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01-04-2012 | Original article

Integrated boost IMRT with FET-PET-adapted local dose escalation in glioblastomas

Results of a prospective phase II study

Authors: M.D. Piroth, M. Pinkawa, R. Holy, J. Klotz, S. Schaar, G. Stoffels, N. Galldiks, H.H. Coenen, H.J. Kaiser, K.J. Langen, M.J. Eble

Published in: Strahlentherapie und Onkologie | Issue 4/2012

Abstract

Purpose

Dose escalations above 60 Gy based on MRI have not led to prognostic benefits in glioblastoma patients yet. With positron emission tomography (PET) using [¹⁸F]fluorethyl-L-tyrosine (FET), tumor coverage can be optimized with the option of regional dose escalation in the area of viable tumor tissue.

Methods and materials

In a prospective phase II study (January 2008 to December 2009), 22 patients (median age 55 years) received radiochemotherapy after surgery. The radiotherapy was performed as an MRI and FET-PET-based integrated-boost intensity-modulated radiotherapy (IMRT). The prescribed dose was 72 and 60 Gy (single dose 2.4 and 2.0 Gy, respectively) for the FET-PET- and MR-based PTV-FET_(72 Gy) and PTV-MR_(60 Gy). FET-PET and MRI were performed routinely for follow-up. Quality of life and cognitive aspects were recorded by the EORTC-QLQ-C30/QLQ Brain20 and Mini-Mental Status Examination (MMSE), while the therapy-related toxicity was recorded using the CTC3.0 and RTOG scores.

Results

Median overall survival (OS) and disease-free survival (DFS) were 14.8 and 7.8 months, respectively. All local relapses were detected at least partly within the 95% dose volume of PTV-MR_(60 Gy). No relevant radiotherapy-related side effects were observed (excepted alopecia). In 2 patients, a pseudoprogression was observed in the MRI. Tumor progression could be excluded by FET-PET and was confirmed in further MRI and FET-PET imaging. No significant changes were observed in MMSE scores and in the EORTC QLQ-C30/QLQ-Brain20 questionnaires.

Conclusion

Our dose escalation concept with a total dose of 72 Gy, based on FET-PET, did not lead to a survival benefit. Acute and late toxicity were not increased, compared with historical controls and published dose–escalation studies.

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Title: Integrated boost IMRT with FET-PET-adapted local dose escalation in glioblastomas
Results of a prospective phase II study
Authors: M.D. Piroth
M. Pinkawa
R. Holy
J. Klotz
S. Schaar
G. Stoffels
N. Galldiks
H.H. Coenen
H.J. Kaiser
K.J. Langen
M.J. Eble
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: Strahlentherapie und Onkologie / Issue 4/2012
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-011-0060-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Integrated boost IMRT with FET-PET-adapted local dose escalation in glioblastomas

Results of a prospective phase II study

Abstract

Purpose

Methods and materials

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods and materials

Results

Conclusion

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