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Open Access 01-12-2014 | Research

Re-irradiation of recurrent glioblastoma multiforme using ¹¹C-methionine PET/CT/MRI image fusion for hypofractionated stereotactic radiotherapy by intensity modulated radiation therapy

Authors: Kazuhiro Miwa, Masayuki Matsuo, Shin-ichi Ogawa, Jun Shinoda, Kazutoshi Yokoyama, Jitsuhiro Yamada, Hirohito Yano, Toru Iwama

Published in: Radiation Oncology | Issue 1/2014

Abstract

Background

This research paper presents a valid treatment strategy for recurrent glioblastoma multiforme (GBM) using hypofractionated stereotactic radiotherapy by intensity modulated radiation therapy (HS-IMRT) planned with ¹¹C-methionine positron emission tomography (MET-PET)/computed tomography (CT)/magnetic resonance imaging (MRI) fusion.

Methods

Twenty-one patients with recurrent GBM received HS-IMRT planned by MET-PET/CT/MRI. The region of increased amino acid tracer uptake on MET-PET was defined as the gross tumor volume (GTV). The planning target volume encompassed the GTV by a 3-mm margin. Treatment was performed with a total dose of 25- to 35-Gy, given as 5- to 7-Gy daily for 5 days.

Results

With a median follow-up of 12 months, median overall survival time (OS) was 11 months from the start of HS-IMRT, with a 6-month and 1-year survival rate of 71.4% and 38.1%, respectively. Karnofsky performance status was a significant prognostic factor of OS as tested by univariate and multivariate analysis. Re-operation rate was 4.8% for radiation necrosis. No other acute or late toxicity Grade 3 or higher was observed.

Conclusions

This is the first prospective study of biologic imaging optimized HS-IMRT in recurrent GBM. HS-IMRT with PET data seems to be well tolerated and resulted in a median survival time of 11 months after HS-IMRT.

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Iuchi T, Hatano K, Narita Y, Kodama T, Yamaki T, Osato K: Hypofractionated high-dose irradiation for the treatment of malignant astrocytomas using simultaneous integrated boost technique by IMRT. Int J Radiat Oncol Biol Phys 2006, 64: 1317-1324.CrossRefPubMed

Sultanem K, Patrocinio H, Lambert C, Corns R, Leblanc R, Parker W, Shenouda G, Souhami L: The use of hypofractionated intensity-modulated irradiation in the treatment of glioblastoma multiforme: preliminary results of a prospective trial. Int J Radiat Oncol Biol Phys 2004, 58: 247-252.CrossRefPubMed

Floyd NS, Woo SY, The BS, Prado C, Mai WY, Trask T, Gildenberg PL, Holoye P, Augspurger ME, Carpenter LS, Lu HH, Chiu JK, Grant WH 3rd, Butler EB: Hypofractionated intensity-modulated radiotherapy for primary glioblastoma multiforme. Int J Radiat Oncol Biol Phys 2004, 58: 721-726.CrossRefPubMed

Panet-Raymond V, Souhami L, Roberge D, Kavan P, Shakibnia L, Muanza T, Lambert C, Leblanc R, Del Maestro R, Guiot MC, Shenouda G: Accelerated hypofractionated intensity-modulated radiotherapy with concurrent and adjuvant temozolomide for patients with glioblastoma multiforme: a safety and efficacy analysis. Int J Radiat Oncol Biol Phys 2009, 73: 473-478.CrossRefPubMed

Grosu AL, Weber WA, Franz M, Stärk S, Piert M, Thamm R, Gumprecht H, Schwaiger M, Molls M, Nieder C: 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: 511-519.CrossRefPubMed

Pirotte B, Goldman S, Dewitte O, Massager N, Wikler D, Lefranc F, Ben Taib NO, Rorive S, David P, Brotchi J, Levivier M: Integrated positron emission tomography and magnetic resonance imaging-guided resection of brain tumors: a report of 103 consecutive procedures. J Neurosurg 2006, 104: 238-253.CrossRefPubMed

Mosskin M, Ericson K, Hindmarsh T, von Holst H, Collins VP, Bergström M, Eriksson L, Johnström P: Positron emission tomography compared with magnetic resonance imaging and computed tomography in supratentorial gliomas using multiple stereotactic biopsies as reference. Acta Radiol 1989, 30: 225-232.CrossRefPubMed

Ogawa T, Shishido F, Kanno I, Inugami A, Fujita H, Murakami M, Shimosegawa E, Ito H, Hatazawa J, Okudera T: Cerebral glioma: evaluation with methionine PET. Radiology 1993, 186: 45-53.CrossRefPubMed

Miwa K, Shinoda J, Yano H, Okumura A, Iwama T, Nakashima T, Sakai N: Discrepancy between lesion distributions on methionine PET and MR images in patients with glioblastoma multiforme: insight from a PET and MR fusion image study. J Neurol Neurosurg Psychiatry 2004, 75: 1457-1462.PubMedCentralCrossRefPubMed

10.

Matsuo M, Miwa K, Tanaka O, Shinoda J, Nishibori H, Tsuge Y, Yano H, Iwama T, Hayashi S, Hoshi H, Yamada J, Kanematsu M, Aoyama H: Impact of [(11)C] Methionine positron emission tomography for target definition of glioblastoma multiforme in radiation therapy planning. Int J Radiat Oncol Biol Phys 2012,2012(82):83-89.CrossRef

11.

Miwa K, Matsuo M, Shinoda J, Oka N, Kato T, Okumura A, Ueda T, Yokoyama K, Yamada J, Yano H, Yoshimura S, Iwama T: Simultaneous integrated boost technique by helical tomotherapy for the treatment of glioblastoma multiforme with 11C-methionine PET: report of three cases. J Neurooncol 2008, 87: 333-339.CrossRefPubMed

12.

Terakawa Y, Tsuyuguchi N, Iwai Y, Yamanaka K, Higashiyama S, Takami T, Ohata K: Diagnostic accuracy of 11C-methionine PET for differentiation of recurrent brain tumors from radiation necrosis after radiotherapy. J Nucl Med 2008, 49: 694-699.CrossRefPubMed

13.

Grosu AL, Lachner R, Wiedenmann N, Stärk S, Thamm R, Kneschaurek P, Schwaiger M, Molls M, Weber WA: Validation of a method for automatic image fusion (BrainLAB system) of CT data and 11C-methionine PET data for stereotactic radiotherapy using a LINAC: first clinical experience. Int J Radiat Oncol Biol Phys 2003, 56: 1450-1463.CrossRefPubMed

14.

Grosu AL, Weber WA, Riedel E, Jeremic B, Nieder C, Franz M, Gumprecht H, Jaeger R, Schwaiger M, Molls M: L-(methyl-11C) methionine positron emissions tomography for target delineation in resected high grade gliomas before radiation therapy. Int J Radiat Oncol Biol Phys 2005, 63: 64-74.CrossRefPubMed

15.

Lee IH, Piert M, Gomez-Hassan D, Junck L, Rogers L, Hayman J, Ten Haken RK, Lawrence TS, Cao Y, Tsien C: 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: 479-485.PubMedCentralCrossRefPubMed

16.

Kracht LW, Miletic H, Busch S, Jacobs AH, Voges J, Hoevels M, Klein JC, Herholz K, Heiss WD: Delineation of brain tumor extent with [11C] L-methionine positron emission tomography: local comparison with stereotactic histopathology. Clin Cancer Res 2004, 10: 7163-7170.CrossRefPubMed

17.

Kinoshita M, Hashimoto N, Goto T, Yanagisawa T, Okita Y, Kagawa N, Kishima H, Tanaka H, Fujita N, Shimosegawa E, Hatazawa J, Yoshimine T: Use of fractional anisotropy for determination of the cut-off value in 11C-methionine positron emission tomography for glioma. Neuroimage 2009, 45: 312-318.CrossRefPubMed

18.

Takenaka S, Asano Y, Shinoda J, Nomura Y, Yonezawa S, Miwa K, Yano H, Iwama T: Comparison of 11C-methionine, 11C-choline, and 18F-fluorodeoxyglucose-PET for distinguishing glioma recurrence from radiation necrosis. Neurol Med Chir (Tokyo) 2014, 54: 280-289.CrossRef

19.

Combs SE, Thilmann C, Edler L, Debus J, Schulz-Ertner D: Efficacy of fractionated stereotactic reirradiation in recurrent gliomas: long-term result in 172 patients treated in a single institution. J Clin Oncol 2005, 23: 8863-8869.CrossRefPubMed

20.

Ernst-Stecken A, Ganslandt O, Lambrecht U, Sauer R, Grabenbauer G: Survival and quality of life after hypofractionatedstereotactic radiotherapy for recurrent malignant glioma. J Neurooncol 2007, 81: 287-294.CrossRefPubMed

21.

Fokas E, Wacker U, Gross MW, Henzel M, Encheva E, Engenhart-Cabillic R: Hypofractionated stereotactic reirradiation of recurrent glioblastomas: a beneficial treatment option after high-dose radiotherapy? Strahlenther Onkol 2009, 185: 235-240.CrossRefPubMed

22.

Henke G, Paulsen F, Steinbach JP, Ganswindt U, Isijanov H, Kortmann RD, Bamberg M, Belka C: Hypofractionated reirradiation for recurrent malignant glioma. Strahlenther Onkol 2009, 185: 113-119.CrossRefPubMed

23.

Fogh SE, Andrews DW, Glass J, Curran W, Glass C, Champ C, Evans JJ, Hyslop T, Pequignot E, Downes B, Comber E, Maltenfort M, Dicker AP, Werner-Wasik M: Hypofractionated stereotactic radiation therapy: an effective therapy for recurrent high-grade gliomas. J Clin Oncol 2010, 28: 3048-3053.PubMedCentralCrossRefPubMed

24.

Gutin PH, Prados MD, Phillips TL, Wara WM, Larson DA, Leibel SA, Sneed PK, Levin VA, Weaver KA, Silver P: External irradiation followed by an interstitial high activity iodine-125 implant “boost” in the initial treatment of malignant gliomas: NCOG study 6G-82-2. Int J Radiat Oncol Biol Phys 1991, 21: 601-606.CrossRefPubMed

25.

Hall WA, Djalilian HR, Sperduto PW, Cho KH, Gerbi BJ, Gibbons JP, Rohr M, Clark HB: Stereotactic radiosurgery for recurrent malignant gliomas. J Clin Oncol 1995, 13: 1642-1648.PubMed

Title: Re-irradiation of recurrent glioblastoma multiforme using 11C-methionine PET/CT/MRI image fusion for hypofractionated stereotactic radiotherapy by intensity modulated radiation therapy
Authors: Kazuhiro Miwa
Masayuki Matsuo
Shin-ichi Ogawa
Jun Shinoda
Kazutoshi Yokoyama
Jitsuhiro Yamada
Hirohito Yano
Toru Iwama
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-9-181

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Re-irradiation of recurrent glioblastoma multiforme using ¹¹C-methionine PET/CT/MRI image fusion for hypofractionated stereotactic radiotherapy by intensity modulated radiation therapy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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