Mahase Sean S, Roth O'Brien Diana A, No Diana, Roytman Michelle, Skafida Myrto E, Lin Eaton, Karakatsanis Nicolas A, Osborne Joseph R, Brandmaier Andrew, Pannullo Susan C, Ramakrishna Rohan, Stieg Philip E, Knisely Jonathan P S, Ivanidze Jana
Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA.
Department of Radiology, Weill Cornell Medicine, New York, New York, USA.
Neurooncol Adv. 2021 Jan 21;3(1):vdab012. doi: 10.1093/noajnl/vdab012. eCollection 2021 Jan-Dec.
Meningiomas express high levels of somatostatin receptor 2 (SSTR2). SSTR2-targeted PET imaging with [Ga]-DOTATATE can aid with distinguishing residual meningioma from reactive changes in the postoperative setting. We present initial dosimetric analyses, acute events, and local control data utilizing [Ga]-DOTATATE PET/MRI-assisted target delineation for prospectively-treated intermediate-risk meningiomas.
Twenty-nine patients underwent DOTATATE PET/MRI meningioma evaluation in 2019. Eight patients with 9 postoperative meningiomas met RTOG 0539 intermediate-risk criteria (recurrent WHO grade I, 1/9; WHO grade II, 8/9). Target volumes were created using DOTATATE PET/MRI to determine residual disease and received a nominal dose of 35.0 Gy over 5 fractions. For comparison, cases were recontoured and planned with MRI alone per RTOG 0539 guidelines. Mean and maximum equivalent 2 Gy doses were generated for target volumes and organs at risk (OAR) within 1 cm of the PTV and compared using Wilcoxon matched pairs signed rank test.
DOTATATE PET/MRI-guided planning significantly reduced mean PTV (11.12 cm compared to 71.39 cm based on MRI alone, < .05) and mean and max dose to the whole brain, optic nerves, and scalp. PET/MRI plans resulted in at least 50% reduction of mean and max doses to the lens, eyes, chiasm, cochlea, brainstem, and hippocampi. One patient experienced focal alopecia. There were no local recurrences at 6 months.
Incorporating DOTATATE-PET/MRI for postoperative target delineation in patients with intermediate-risk intracranial meningiomas results in PTV reduction and decreased OAR dose. Our findings warrant larger studies evaluating DOTATATE-PET/MRI in the radiotherapeutic planning of postoperative meningiomas.
脑膜瘤表达高水平的生长抑素受体2（SSTR2）。使用[镓] - DOTATATE进行的SSTR2靶向PET成像有助于在术后区分残留脑膜瘤与反应性改变。我们展示了利用[镓] - DOTATATE PET/MRI辅助靶区勾画对前瞻性治疗的中危脑膜瘤进行的初始剂量分析、急性事件和局部控制数据。
2019年，29例患者接受了DOTATATE PET/MRI脑膜瘤评估。8例患者的9个术后脑膜瘤符合RTOG 0539中危标准（复发性世界卫生组织I级，1/9；世界卫生组织II级，8/9）。使用DOTATATE PET/MRI创建靶区体积以确定残留疾病，并接受5次分割、名义剂量为35.0 Gy的照射。为作比较，根据RTOG 0539指南，仅用MRI对病例进行重新勾画和计划。生成靶区体积和距计划靶体积（PTV）1 cm内的危及器官（OAR）的平均和最大等效2 Gy剂量，并使用Wilcoxon配对符号秩检验进行比较。
DOTATATE PET/MRI引导的计划显著降低了平均PTV（基于MRI单独测量为71.39 cm，而PET/MRI引导下为11.12 cm，P <.05）以及对全脑、视神经和头皮的平均和最大剂量。PET/MRI计划使晶状体、眼睛、视交叉、耳蜗、脑干和海马体的平均和最大剂量至少降低了50%。1例患者出现局灶性脱发。6个月时无局部复发。
将DOTATATE - PET/MRI纳入中危颅内脑膜瘤患者的术后靶区勾画可导致PTV减小和OAR剂量降低。我们的研究结果值得开展更大规模的研究来评估DOTATATE - PET/MRI在术后脑膜瘤放射治疗计划中的应用。
