Sipos Dávid, Tóth Zoltán, Lukács Gábor, Bajzik Gábor, Hadjiev Janaki, Cselik Zsolt, Repa Imre, Kovács Árpád
Pécsi Tudományegyetem, Egészségtudományi Kar, Doktori Iskola, Pécs.
Pécsi Tudományegyetem, Egészségtudományi Kar, Diagnosztikai Intézet, Pécs.
Ideggyogy Sz. 2019 May 30;72(5-6):209-215. doi: 10.18071/isz.72.0209.
Radiotherapy plays important role in the complex oncological treatment of glioblastoma multiforme (GBM). The modern 3D radiotherapy treatments are based on cross-sectional CT and MR information, however more attention is being paid to functional hybrid imaging describing the biological and functional morphology of tumor lesions. 18F-DOPA is an amino acid tracer with high specificity and sensitivity, which may play an important role in the precise definition of target volume in the irradiation process of GBM patients. Our study presents the first experiences with 18F-DOPA based PET/CT/MR 3D irradiation planning process.
In Hungary the 18F-DOPA radiotracer has been available for clinical use since September 2017. Between September 2017 and January 2018, at the Somogy County Kaposi Mór Teaching Hospital Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center 3 histologically verified glioblastoma multiforme patients received 18F-DOPA based 3D irradiation treatment. In the contouring process the native planning CT scanes were fused with the PET/MR series (T1 contrast enhanced, T2 and 18F-DOPA sequences). We defined 18F-DOPA uptake volume (BTV-F-DOPA), the T1 contrast enhanced MRI volume (GTV-T1CE), and the volume of the area covered by oedema on the T2 weighted MRI scan (CTV-oedema) in all patients. We also registered the BTV-F-DOPA volumes not covered by the conventional MR based target volumes.
Examining the 3 cases, the average volume of 18F-DOPA tumor was 22.7 cm3 (range 15.3-30.9; SD = 7.82). The average GTV T1 CE was found to be 8.7 cm3 (range 3.8-13.2; SD = 4.70). The mean CTV oedema volume was 40.3 cm3 (range 27.7-57.7; SD = 15.36). A non-overlapping target volume difference (BTV-F-DOPA not covered by CTV oedema area) was 4.5 cm3 (range 1-10.3; SD = 5.05) for PTV definition.
Based on our results the tumor area defined by the amino acid tracer is not fully identical with the MRI defined T2 oedema CTV. 18F-DOPA defined BTV can modify the definiton of the PTV, and the radiotherapy treatment.
放射治疗在多形性胶质母细胞瘤（GBM）的综合肿瘤治疗中发挥着重要作用。现代三维放射治疗基于横断面CT和MR信息，但目前越来越关注描述肿瘤病变生物学和功能形态的功能混合成像。18F-DOPA是一种具有高特异性和敏感性的氨基酸示踪剂，可能在GBM患者放疗过程中靶区体积的精确界定中发挥重要作用。我们的研究展示了基于18F-DOPA的PET/CT/MR三维放疗计划过程的初步经验。
在匈牙利，自2017年9月起18F-DOPA放射性示踪剂可用于临床。2017年9月至2018年1月期间，在绍莫吉州卡波西·莫尔教学医院约瑟夫·巴卡博士诊断、放射肿瘤学、研究与教学中心，3例经组织学证实的多形性胶质母细胞瘤患者接受了基于18F-DOPA的三维放射治疗。在勾画轮廓过程中，将原始计划CT扫描与PET/MR系列（T1增强、T2和18F-DOPA序列）进行融合。我们确定了所有患者的18F-DOPA摄取体积（BTV-F-DOPA）、T1增强MRI体积（GTV-T1CE）以及T2加权MRI扫描上水肿区域的体积（CTV-水肿）。我们还记录了传统MR定义的靶区体积未覆盖的BTV-F-DOPA体积。
检查这3例病例，18F-DOPA肿瘤的平均体积为22.7 cm³（范围15.3 - 30.9；标准差 = 7.82）。发现GTV T1 CE的平均体积为8.7 cm³（范围3.8 - 13.2；标准差 = 4.70）。CTV水肿的平均体积为40.3 cm³（范围27.7 - 57.7；标准差 = 15.36）。对于计划靶区（PTV）定义，非重叠靶区体积差异（CTV水肿区域未覆盖的BTV-F-DOPA）为4.5 cm³（范围1 - 10.3；标准差 = 5.05）。
基于我们的结果，氨基酸示踪剂定义的肿瘤区域与MRI定义的T2水肿CTV并不完全相同。18F-DOPA定义的BTV可修改PTV的定义以及放射治疗。
