Miwa Kazuhiro, Matsuo Masayuki, Shinoda Jun, Oka Naoki, Kato Takayuki, Okumura Ayumi, Ueda Tatsuya, Yokoyama Kazutoshi, Yamada Jitsuhiro, Yano Hirohito, Yoshimura Shinichi, Iwama Toru
Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, 630 Shimokobi, Kobi-cho, Minokamo, Gifu 505-0034, Japan.
J Neurooncol. 2008 May;87(3):333-9. doi: 10.1007/s11060-008-9519-3. Epub 2008 Jan 24.
We performed hypofractionated high-dose irradiation of a patient's residual glioblastoma multiforme using a simultaneous integrated boost (SIB) technique with helical tomotherapy system (HT) planning. The gross tumor volume (GTV)-1 was defined as the area of intensive (11)C-methionine (MET) uptake and GTV-2 was defined as the area of moderate MET uptake. The planning target volume (PTV)-1 encompassed GTV-1 plus a 5 mm margin, and PTV-2 encompassed GTV-2 plus a 2 mm margin. SIB with HT was performed in eight fractions, planning the dose for GTV-1 at 68 Gy (biologically effective dose: BED = 126 Gy), PTV-1 at 56 Gy (BED = 95 Gy), and PTV-2 at 40 Gy (BED = 60 Gy). In each of the target areas, the uptake value on (11)C-methionine positron emission tomography (MET-PET) was considerably decreased following SIB, although no remarkable changes were demonstrated on magnetic resonance imaging (MRI). These cases demonstrate that SIB with HT planning using MET-PET offers excellent target coverage and uniformity. In addition, SIB with HT planning using MET-PET is organ sparing and MET-PET has great efficacy for monitoring treatment response after SIB. To more clearly define the impact of SIB with HT planning using MET-PET, further investigations are required.
我们使用螺旋断层放射治疗系统（HT）计划的同步整合加量（SIB）技术，对一名多形性胶质母细胞瘤残留患者进行了大分割高剂量照射。大体肿瘤体积（GTV）-1定义为（11）C-蛋氨酸（MET）摄取密集的区域，GTV-2定义为MET摄取中等的区域。计划靶体积（PTV）-1包括GTV-1加上5毫米的边界，PTV-2包括GTV-2加上2毫米的边界。采用HT的SIB分八次进行，计划GTV-1的剂量为68 Gy（生物等效剂量：BED = 126 Gy），PTV-1的剂量为56 Gy（BED = 95 Gy），PTV-2的剂量为40 Gy（BED = 60 Gy）。在每个靶区，SIB后（11）C-蛋氨酸正电子发射断层扫描（MET-PET）上的摄取值显著降低，尽管磁共振成像（MRI）上未显示明显变化。这些病例表明，使用MET-PET的HT计划SIB提供了出色的靶区覆盖和均匀性。此外，使用MET-PET的HT计划SIB可减少对器官的照射，且MET-PET对监测SIB后的治疗反应具有很大的功效。为了更清楚地界定使用MET-PET的HT计划SIB的影响，还需要进一步研究。
