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碳离子放疗治疗复发性高级别胶质瘤中 F-FET PET 对靶区定义和肿瘤进展的影响。

Impact of F-FET PET on Target Volume Definition and Tumor Progression of Recurrent High Grade Glioma Treated with Carbon-Ion Radiotherapy.

机构信息

German Cancer Consortium (DKTK), Heidelberg, Germany.

Translational Radiation Oncology, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany.

出版信息

Sci Rep. 2018 May 8;8(1):7201. doi: 10.1038/s41598-018-25350-7.

DOI:10.1038/s41598-018-25350-7
PMID:29740097
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5940831/
Abstract

High-precision radiotherapy (HPR) of recurrent high grade glioma (HGG) requires accurate spatial allocation of these infiltrative tumors. We investigated the impact of F-FET PET on tumor delineation and progression of recurrent HGG after HPR with carbon ions. T contrast enhanced MRI and F-FET-PET scans of 26 HGG patients were fused with radiotherapy planning volumes. PET-positive (PET+) tumor volumes using different isocontours (I%) were systematically investigated and compared with MRI-derived gross tumor volumes (GTV). Standardized uptake ratios (SUR) were further correlated with GTV and tumor progression patterns. In grade IV glioma, SUR > 2.92 significantly correlated with poor median overall survival (6.5 vs 13.1 months, p = 0.00016). We found no reliable SUR cut-off criteria for definition of PET+ volumes. Overall conformity between PET and MRI-based contours was low, with maximum conformities between 0.42-0.51 at I40%. The maximum sensitivity and specificity for PET+ volumes outside of GTV predicting tumor progression were 0.16 (I40%) and 0.52 (I50%), respectively. In 75% of cases, FLAIR hyperintense area covered over 80% of PET+ volumes. F-FET-PET derived SUR has a prognostic impact in grade IV glioma. The value of substantial mismatches between MRI-based GTV and PET+ volumes to improve tumor delineation in radiotherapy awaits further validation in randomized prospective trials.

摘要

复发性高级别胶质瘤（HGG）的高精度放疗（HPR）需要准确分配这些浸润性肿瘤的空间位置。我们研究了 F-FET PET 对碳离子 HPR 后复发性 HGG 肿瘤勾画和进展的影响。26 例 HGG 患者的 T 对比增强 MRI 和 F-FET-PET 扫描与放射治疗计划体积融合。系统研究并比较了不同等剂量线（I%）的 PET 阳性（PET+）肿瘤体积与 MRI 衍生的大体肿瘤体积（GTV）。进一步将标准化摄取值（SUR）与 GTV 和肿瘤进展模式相关联。在 IV 级胶质瘤中，SUR>2.92 与较差的中位总生存期显著相关（6.5 与 13.1 个月，p=0.00016）。我们没有发现可靠的 SUR 截断标准来定义 PET+体积。PET 和基于 MRI 的轮廓之间的总体一致性较低，在 I40%时最大一致性为 0.42-0.51。预测肿瘤进展时，GTV 外 PET+体积的最大灵敏度和特异性分别为 0.16（I40%）和 0.52（I50%）。在 75%的情况下，FLAIR 高信号区覆盖了超过 80%的 PET+体积。在 IV 级胶质瘤中，F-FET-PET 衍生的 SUR 具有预后影响。在随机前瞻性试验中进一步验证之前，MRI 基于 GTV 和 PET+体积之间大量不匹配以改善放疗肿瘤勾画的价值尚待验证。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1466/5940831/2af92e9a3d47/41598_2018_25350_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1466/5940831/051052b87159/41598_2018_25350_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1466/5940831/bc08f2ea53f0/41598_2018_25350_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1466/5940831/a36ee1eea765/41598_2018_25350_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1466/5940831/aab63f6c6b85/41598_2018_25350_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1466/5940831/2af92e9a3d47/41598_2018_25350_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1466/5940831/051052b87159/41598_2018_25350_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1466/5940831/bc08f2ea53f0/41598_2018_25350_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1466/5940831/a36ee1eea765/41598_2018_25350_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1466/5940831/aab63f6c6b85/41598_2018_25350_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1466/5940831/2af92e9a3d47/41598_2018_25350_Fig5_HTML.jpg

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