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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 6/2020

01-06-2020 | Meningioma | Original Article

Integration of PET-imaging into radiotherapy treatment planning for low-grade meningiomas improves outcome

Authors: Kerstin A. Kessel, Wolfgang Weber, Igor Yakushev, Hanna Fischer, Theresa Voglhuber, Christian Diehl, Christoph Straube, Claus Zimmer, Benedikt Wiestler, Jens Gempt, Bernhard Meyer, Stephanie E. Combs

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 6/2020

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Abstract

Purpose

Meningiomas have an excellent survival prognosis, and radiotherapy (RT) is a central component of interdisciplinary treatment. During treatment planning, the definition of the target volume remains challenging using MR and CT imaging alone. This is the first study to analyze the impact of additional PET-imaging on local control (LC) and overall survival (OS) after high-precision RT.

Methods

We analyzed 339 meningiomas treated between 2000 and 2018. For analyses, we divided the patients in low-grade (n = 276) and high-grade (n = 63) cases. We performed RT in an adjuvant setting due to subtotal resection or later due to recurrent tumor growth. The target volumes were delineated based on diagnostic CT and MRI and, if available, additional PET-imaging (low-grade: n = 164, 59.4%; high-grade: n = 39, 61.9%) with either 68Ga-Dotanoc/Dotatoc, 18F-fluoroethyltyrosine or 11C-methionine tracer. Patients were treated with fractionated stereotactic RT with a median total dose and dose per fraction of 54 Gy and 1.8 Gy, respectively.

Results

Median follow-up was 5.6 years. For low-grade meningiomas, mean OS was 15.6 years and mean LC was 16.9 years; for high-grade cases mean OS was 11.6 years, and mean LC was 11.1 years. In univariate analyses, PET-imaging had a significant impact on OS (p = 0.035) and LC (p = 0.041) for low-grade meningiomas and remained significant (p = 0.015) for LC in the multivariate analysis. For high-grade cases, PET did not influence both OS and LC. Further prognostic factors could be identified.

Conclusions

For low-grade meningiomas, we showed that the addition of PET-imaging for target volume definition led to a significantly enhanced LC. Thus, PET improves the detection of tumor cells and helps distinguish between healthy tissue and meningioma tissue, especially during the treatment planning process.
Appendix
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Metadata
Title
Integration of PET-imaging into radiotherapy treatment planning for low-grade meningiomas improves outcome
Authors
Kerstin A. Kessel
Wolfgang Weber
Igor Yakushev
Hanna Fischer
Theresa Voglhuber
Christian Diehl
Christoph Straube
Claus Zimmer
Benedikt Wiestler
Jens Gempt
Bernhard Meyer
Stephanie E. Combs
Publication date
01-06-2020
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 6/2020
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-019-04591-2

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