title: Transcranial sonography: integration into target volume definition for glioblastoma multiforme.
abstract: OBJECTIVE
  Recent studies indicate that transcranial sonography (TCS) reliably displays the extension of malignant brain tumors. The effect of integrating TCS into radiotherapy planning for glioblastoma multiforme (GBM) was investigated herein.
  
  
  METHODS
  Thirteen patients subtotally resected for GBM underwent TCS during radiotherapy planning and were conventionally treated (54 to 60 Gy). Gross tumor volumes (GTVs) and stereotactic boost planning target volumes (PTVs, 3-mm margin) were created, based on contrast enhancement on computed tomography (CT) only (PTV(CT)) or the combined CT and TCS information (PTV(CT+TCS)). Noncoplonar conformal treatment plans for both PTVs were compared. Tumor progression patterns and preoperative magnetic resonance imaging (MRI) were related to both PTVs.
  
  
  RESULTS
  A sufficient temporal bone window for TCS was present in 11 of 13 patients. GTVs as defined by TCS were considerably larger than the respective CT volumes: Of the composite GTV(CT+TCS) (median volume 42 ml), 23%, 13%, and 66% (medians) were covered by the overlap of both methods, CT only and TCS only, respectively. Median sizes of PTV(CT) and PTV(CT+TCS) were 34 and 74 ml, respectively. Addition of TCS to CT information led to a median increase of the volume irradiated within the 80% isodose by 32 ml (median factor 1.51). PTV(CT+TCS) volume was at median 24% of a "conventional" MRI(T2)-based PTV. Of eight progressions analyzed, three and six occurred inside the 80% isodose of the plans for PTV(CT) and for PTV(CT+TCS), respectively.
  
  
  CONCLUSIONS
  Addition of TCS tumor volume to the contrast-enhancing CT volume in postoperative radiotherapy planning for GBM increases the treated volume by a median factor of 1.5. Since a high frequency of marginal recurrences is reported from dose-escalation trials of this disease, TCS may complement established methods in PTV definition.
authors.affiliation: Department of Radiation Oncology, University of Wuerzburg, Germany. vordermark@strahlentherapie.uni-wuerzberg.de
authors.forename: D
authors.initials: D
authors.lastname: Vordermark
authors.forename: G
authors.initials: G
authors.lastname: Becker
authors.forename: M
authors.initials: M
authors.lastname: Flentje
authors.forename: S
authors.initials: S
authors.lastname: Richter
authors.forename: I
authors.initials: I
authors.lastname: Goerttler-Krauspe
authors.forename: O
authors.initials: O
authors.lastname: Koelbl
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D011881:Radiotherapy, Computer-Assisted; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial