Simultaneous integrated boost technique by helical tomotherapy for the treatment of glioblastoma multiforme with 11C-methionine PET: report of three cases.
We performed hypofractionated high-dose irradiation of a patient's residual glioblastoma multiforme using a simultaneous integrated boost (SIB) technique with helical tomotherapy system (HT) planning. The gross tumor volume (GTV)-1 was defined as the area of intensive (11)C-methionine (MET) uptake and GTV-2 was defined as the area of moderate MET uptake. The planning target volume (PTV)-1 encompassed GTV-1 plus a 5 mm margin, and PTV-2 encompassed GTV-2 plus a 2 mm margin. SIB with HT was performed in eight fractions, planning the dose for GTV-1 at 68 Gy (biologically effective dose: BED = 126 Gy), PTV-1 at 56 Gy (BED = 95 Gy), and PTV-2 at 40 Gy (BED = 60 Gy). In each of the target areas, the uptake value on (11)C-methionine positron emission tomography (MET-PET) was considerably decreased following SIB, although no remarkable changes were demonstrated on magnetic resonance imaging (MRI). These cases demonstrate that SIB with HT planning using MET-PET offers excellent target coverage and uniformity. In addition, SIB with HT planning using MET-PET is organ sparing and MET-PET has great efficacy for monitoring treatment response after SIB. To more clearly define the impact of SIB with HT planning using MET-PET, further investigations are required.
Miwa
Kazuhiro
K
Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, 630 Shimokobi, Kobi-cho, Minokamo, Gifu 505-0034, Japan. doctor.3@jasmine.ocn.ne.jp
Matsuo
Masayuki
M
Shinoda
Jun
J
Oka
Naoki
N
Kato
Takayuki
T
Okumura
Ayumi
A
Ueda
Tatsuya
T
Yokoyama
Kazutoshi
K
Yamada
Jitsuhiro
J
Yano
Hirohito
H
Yoshimura
Shinichi
S
Iwama
Toru
T
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000532:radiotherapy*; D002250:Carbon Radioisotopes; D005260:Female; D005909:Glioblastoma / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008715:Methionine; D018365:Neoplasm, Residual; D038361:Neuronavigation; D049268:Positron-Emission Tomography; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D020266:Radiotherapy, Conformal / Q000379:methods*; D036542:Tomography, Spiral Computed / Q000379:methods*
D002250:Carbon Radioisotopes; D008715:Methionine