Additional Value of 18F-FDOPA Amino Acid Analog Radiotracer to Irradiation Planning Process of Patients With Glioblastoma Multiforme
PurposeTo investigate the added value of 6-(18F]-fluoro-L-3,4-dihydroxyphenylalanine (FDOPA) PET to radiotherapy planning in glioblastoma multiforme (GBM).MethodsFrom September 2017 to December 2020, 17 patients with GBM received external beam radiotherapy up to 60 Gy with concurrent and adjuvant te...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-07-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.699360/full |
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| author | David Sipos David Sipos David Sipos Zoltan László Zoltan Tóth Zoltan Tóth Peter Kovács Peter Kovács Jozsef Tollár Jozsef Tollár Akos Gulybán Ferenc Lakosi Ferenc Lakosi Imre Repa Imre Repa Arpad Kovács Arpad Kovács Arpad Kovács |
| author_facet | David Sipos David Sipos David Sipos Zoltan László Zoltan Tóth Zoltan Tóth Peter Kovács Peter Kovács Jozsef Tollár Jozsef Tollár Akos Gulybán Ferenc Lakosi Ferenc Lakosi Imre Repa Imre Repa Arpad Kovács Arpad Kovács Arpad Kovács |
| author_sort | David Sipos |
| collection | DOAJ |
| description | PurposeTo investigate the added value of 6-(18F]-fluoro-L-3,4-dihydroxyphenylalanine (FDOPA) PET to radiotherapy planning in glioblastoma multiforme (GBM).MethodsFrom September 2017 to December 2020, 17 patients with GBM received external beam radiotherapy up to 60 Gy with concurrent and adjuvant temozolamide. Target volume delineations followed the European guideline with a 2-cm safety margin clinical target volume (CTV) around the contrast-enhanced lesion+resection cavity on MRI gross tumor volume (GTV). All patients had FDOPA hybrid PET/MRI followed by PET/CT before radiotherapy planning. PET segmentation followed international recommendation: T/N 1.7 (BTV1.7) and T/N 2 (BTV2.0) SUV thresholds were used for biological target volume (BTV) delineation. For GTV-BTVs agreements, 95% of the Hausdorff distance (HD95%) from GTV to the BTVs were calculated, additionally, BTV portions outside of the GTV and coverage by the 95% isodose contours were also determined. In case of recurrence, the latest MR images were co-registered to planning CT to evaluate its location relative to BTVs and 95% isodose contours.ResultsAverage (range) GTV, BTV1.7, and BTV2.0 were 46.58 (6–182.5), 68.68 (9.6–204.1), 42.89 (3.8–147.6) cm3, respectively. HD95% from GTV were 15.5 mm (7.9–30.7 mm) and 10.5 mm (4.3–21.4 mm) for BTV1.7 and BTV2.0, respectively. Based on volumetric assessment, 58.8% (28–100%) of BTV1.7 and 45.7% of BTV2.0 (14-100%) were outside of the standard GTV, still all BTVs were encompassed by the 95% dose. All recurrences were confirmed by follow-up imaging, all occurred within PTV, with an additional outfield recurrence in a single case, which was not DOPA-positive at the beginning of treatment. Good correlation was found between the mean and median values of PET/CT and PET/MRI segmented volumes relative to corresponding brain-accumulated enhancement (r = 0.75; r = 0.72).Conclusion18FFDOPA PET resulted in substantial larger tumor volumes compared to MRI; however, its added value is unclear as vast majority of recurrences occurred within the prescribed dose level. Use of PET/CT signals proved to be feasible in the absence of direct segmentation possibilities of PET/MR in TPS. The added value of 18FFDOPA may be better exploited in the context of integrated dose escalation. |
| first_indexed | 2024-12-23T14:38:39Z |
| format | Article |
| id | doaj.art-c4ff501017bd457583c32cc33a93206c |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-23T14:38:39Z |
| publishDate | 2021-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-c4ff501017bd457583c32cc33a93206c2022-12-21T17:43:16ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-07-011110.3389/fonc.2021.699360699360Additional Value of 18F-FDOPA Amino Acid Analog Radiotracer to Irradiation Planning Process of Patients With Glioblastoma MultiformeDavid Sipos0David Sipos1David Sipos2Zoltan László3Zoltan Tóth4Zoltan Tóth5Peter Kovács6Peter Kovács7Jozsef Tollár8Jozsef Tollár9Akos Gulybán10Ferenc Lakosi11Ferenc Lakosi12Imre Repa13Imre Repa14Arpad Kovács15Arpad Kovács16Arpad Kovács17Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, Kaposvár, HungaryDoctoral School of Health Sciences, University of Pécs, Pécs, HungaryDepartment of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, HungaryDr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, Kaposvár, HungaryDoctoral School of Health Sciences, University of Pécs, Pécs, HungaryMEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, HungaryDr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, Kaposvár, HungaryDepartment of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, HungaryDepartment of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, HungaryDepartment of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, HungaryMedical Physics Department, Institut Jules Bordet, Bruxelles, BelgiumDr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, Kaposvár, HungaryDepartment of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, HungaryDr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, Kaposvár, HungaryDoctoral School of Health Sciences, University of Pécs, Pécs, HungaryDoctoral School of Health Sciences, University of Pécs, Pécs, HungaryDepartment of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, HungaryDepartment of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, HungaryPurposeTo investigate the added value of 6-(18F]-fluoro-L-3,4-dihydroxyphenylalanine (FDOPA) PET to radiotherapy planning in glioblastoma multiforme (GBM).MethodsFrom September 2017 to December 2020, 17 patients with GBM received external beam radiotherapy up to 60 Gy with concurrent and adjuvant temozolamide. Target volume delineations followed the European guideline with a 2-cm safety margin clinical target volume (CTV) around the contrast-enhanced lesion+resection cavity on MRI gross tumor volume (GTV). All patients had FDOPA hybrid PET/MRI followed by PET/CT before radiotherapy planning. PET segmentation followed international recommendation: T/N 1.7 (BTV1.7) and T/N 2 (BTV2.0) SUV thresholds were used for biological target volume (BTV) delineation. For GTV-BTVs agreements, 95% of the Hausdorff distance (HD95%) from GTV to the BTVs were calculated, additionally, BTV portions outside of the GTV and coverage by the 95% isodose contours were also determined. In case of recurrence, the latest MR images were co-registered to planning CT to evaluate its location relative to BTVs and 95% isodose contours.ResultsAverage (range) GTV, BTV1.7, and BTV2.0 were 46.58 (6–182.5), 68.68 (9.6–204.1), 42.89 (3.8–147.6) cm3, respectively. HD95% from GTV were 15.5 mm (7.9–30.7 mm) and 10.5 mm (4.3–21.4 mm) for BTV1.7 and BTV2.0, respectively. Based on volumetric assessment, 58.8% (28–100%) of BTV1.7 and 45.7% of BTV2.0 (14-100%) were outside of the standard GTV, still all BTVs were encompassed by the 95% dose. All recurrences were confirmed by follow-up imaging, all occurred within PTV, with an additional outfield recurrence in a single case, which was not DOPA-positive at the beginning of treatment. Good correlation was found between the mean and median values of PET/CT and PET/MRI segmented volumes relative to corresponding brain-accumulated enhancement (r = 0.75; r = 0.72).Conclusion18FFDOPA PET resulted in substantial larger tumor volumes compared to MRI; however, its added value is unclear as vast majority of recurrences occurred within the prescribed dose level. Use of PET/CT signals proved to be feasible in the absence of direct segmentation possibilities of PET/MR in TPS. The added value of 18FFDOPA may be better exploited in the context of integrated dose escalation.https://www.frontiersin.org/articles/10.3389/fonc.2021.699360/full3,4-dihydroxy-6- [18F] fluoro-l-phenylalanine18F-FDOPApositron emission tomography–computed tomographypositron emission tomography–magnetic resonanceglioblastomairradiation |
| spellingShingle | David Sipos David Sipos David Sipos Zoltan László Zoltan Tóth Zoltan Tóth Peter Kovács Peter Kovács Jozsef Tollár Jozsef Tollár Akos Gulybán Ferenc Lakosi Ferenc Lakosi Imre Repa Imre Repa Arpad Kovács Arpad Kovács Arpad Kovács Additional Value of 18F-FDOPA Amino Acid Analog Radiotracer to Irradiation Planning Process of Patients With Glioblastoma Multiforme Frontiers in Oncology 3,4-dihydroxy-6- [18F] fluoro-l-phenylalanine 18F-FDOPA positron emission tomography–computed tomography positron emission tomography–magnetic resonance glioblastoma irradiation |
| title | Additional Value of 18F-FDOPA Amino Acid Analog Radiotracer to Irradiation Planning Process of Patients With Glioblastoma Multiforme |
| title_full | Additional Value of 18F-FDOPA Amino Acid Analog Radiotracer to Irradiation Planning Process of Patients With Glioblastoma Multiforme |
| title_fullStr | Additional Value of 18F-FDOPA Amino Acid Analog Radiotracer to Irradiation Planning Process of Patients With Glioblastoma Multiforme |
| title_full_unstemmed | Additional Value of 18F-FDOPA Amino Acid Analog Radiotracer to Irradiation Planning Process of Patients With Glioblastoma Multiforme |
| title_short | Additional Value of 18F-FDOPA Amino Acid Analog Radiotracer to Irradiation Planning Process of Patients With Glioblastoma Multiforme |
| title_sort | additional value of 18f fdopa amino acid analog radiotracer to irradiation planning process of patients with glioblastoma multiforme |
| topic | 3,4-dihydroxy-6- [18F] fluoro-l-phenylalanine 18F-FDOPA positron emission tomography–computed tomography positron emission tomography–magnetic resonance glioblastoma irradiation |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.699360/full |
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