[F-18]-fluorodeoxyglucose positron emission tomography for targeting radiation dose escalation for patients with glioblastoma multiforme: clinical outcomes and patterns of failure.
OBJECTIVE
[F-18]-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging for brain tumors has been shown to identify areas of active disease. Radiation dose escalation in the treatment of glioblastoma multiforme may lead to improved disease control. Based on these premises, we initiated a prospective study of FDG-PET for the treatment planning of radiation dose escalation for the treatment of glioblastoma multiforme.


METHODS
Forty patients were enrolled. Patients were treated with standard conformal fractionated radiotherapy with volumes defined by MRI imaging. When patients reached a dose of 45-50.4 Gy, they underwent FDG-PET imaging for boost target delineation, for an additional 20 Gy (2 Gy per fraction) to a total dose of 79.4 Gy (n = 30).


RESULTS
The estimated 1-year and 2-year overall survival (OS) for the entire group was 70% and 17%, respectively, with a median overall survival of 70 weeks. The estimated 1-year and 2-year progression-free survival (PFS) was 18% and 3%, respectively, with a median of 24 weeks. No significant improvements in OS or PFS were observed for the study group in comparison to institutional historical controls.


CONCLUSIONS
Radiation dose escalation to 79.4 Gy based on FDG-PET imaging demonstrated no improvement in OS or PFS. This study establishes the feasibility of integrating PET metabolic imaging into radiotherapy treatment planning.
Douglas
James G
JG
Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA 98195-6043, USA. drjay@u.washington.edu
Stelzer
Keith J
KJ
Mankoff
David A
DA
Tralins
Kevin S
KS
Krohn
Kenneth A
KA
Muzi
Mark
M
Silbergeld
Daniel L
DL
Rostomily
Robert C
RC
Scharnhorst
Jeffrey
J
Spence
Alexander M
AM
D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D005240:Feasibility Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18