镓- DOTATOC 对颅底脑膜瘤放射治疗中正常组织保护的影响：光子和质子放射治疗的差异影响。
Influence of Ga-DOTATOC on sparing of normal tissue for radiation therapy of skull base meningioma: differential impact of photon and proton radiotherapy.
机构信息
Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Deutsches Konsortium für Translationale Krebsforschung (dktk), Partner Site Heidelberg, Heidelberg, Germany.
出版信息
Radiat Oncol. 2018 Apr 2;13(1):58. doi: 10.1186/s13014-018-1008-z.
BACKGROUND
To evaluate the impact of Ga-DOTATOC-PET on treatment planning and sparing of normal tissue in the treatment of skull base meningioma with advanced photons and protons.
METHODS
From the institutional database consisting of 507 skull base meningiomas 10 patients were chosen randomly for the present analysis. Target volume definition was performed based on CT and MRI only, as well as with additional Ga-DOTATOC-PET. Treatment plans were performed for Intensity Modulated Radiotherapy (IMRT) and proton therapy using active raster scanning on both target volumes. We calculated doses to relevant organs at risk (OAR), conformity indices as well as differences in normal tissue sparing between both radiation modalities based on CT/MRI planning as well as CT/MRI/PET planning.
RESULTS
For photon treatment plans, PET-based treatment plans showed a reduction of brain stem D and D for different levels of total dose. At the optic chiasm, use of Ga-DOTATOC significantly reduces D; moreover, the D is reduced in most cases, too. For both right and left optic nerve, reduction of dose by addition of Ga-DOTATOC-PET is minimal and depends on the anatomical location of the meningioma. In protons, the impact of Ga-DOTATOC-PET is minimal compared to photons.
CONCLUSION
Addition of Ga-DOTATOC-PET information into treatment planning for skull base meningiomas has a significant impact on target volumes. In most cases, PET-planning leads to significant reductions of the treatment volumes. Subsequently, reduced doses are applied to OAR. Using protons, the benefit of additional PET is smaller since target coverage is more conformal and dose to OAR is already reduced compared to photons. Therefore, PET-imaging has the greatest margin of benefit in advanced photon techniques, and combination of PET-planning and high-precision treatment leads to comparable treatment plans as with protons.
背景
评估 Ga-DOTATOC-PET 对颅底脑膜瘤高级光子和质子治疗计划和正常组织保护的影响。
方法
从包含 507 例颅底脑膜瘤的机构数据库中，随机选择了 10 名患者进行本分析。靶区定义是基于 CT 和 MRI 进行的，以及额外的 Ga-DOTATOC-PET。使用主动栅格扫描对两个靶区进行强度调制放射治疗 (IMRT) 和质子治疗。我们计算了基于 CT/MRI 计划以及 CT/MRI/PET 计划的相关危及器官 (OAR) 的剂量、适形指数以及两种放射治疗方式在正常组织保护方面的差异。
结果
对于光子治疗计划，基于 PET 的治疗计划显示脑干 D 和不同总剂量水平的 D 降低。在视交叉处，使用 Ga-DOTATOC 可显著降低 D；此外，D 在大多数情况下也降低了。对于左右视神经，添加 Ga-DOTATOC-PET 对剂量的降低最小，取决于脑膜瘤的解剖位置。与光子相比，质子中 Ga-DOTATOC-PET 的影响较小。
结论
将 Ga-DOTATOC-PET 信息添加到颅底脑膜瘤的治疗计划中对靶区有显著影响。在大多数情况下，PET 计划导致治疗体积显著减少。随后，OAR 应用的剂量降低。使用质子，由于靶区覆盖率更符合要求且与光子相比 OAR 的剂量已经降低，因此额外的 PET 的益处较小。因此，PET 成像在高级光子技术中具有最大的获益空间，并且将 PET 计划与高精度治疗相结合可产生与质子相似的治疗计划。
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