title: Re-irradiation of recurrent glioblastoma multiforme using 11C-methionine PET/CT/MRI image fusion for hypofractionated stereotactic radiotherapy by intensity modulated radiation therapy.
abstract: BACKGROUND
  This research paper presents a valid treatment strategy for recurrent glioblastoma multiforme (GBM) using hypofractionated stereotactic radiotherapy by intensity modulated radiation therapy (HS-IMRT) planned with 11C-methionine positron emission tomography (MET-PET)/computed tomography (CT)/magnetic resonance imaging (MRI) fusion.
  
  
  METHODS
  Twenty-one patients with recurrent GBM received HS-IMRT planned by MET-PET/CT/MRI. The region of increased amino acid tracer uptake on MET-PET was defined as the gross tumor volume (GTV). The planning target volume encompassed the GTV by a 3-mm margin. Treatment was performed with a total dose of 25- to 35-Gy, given as 5- to 7-Gy daily for 5 days.
  
  
  RESULTS
  With a median follow-up of 12 months, median overall survival time (OS) was 11 months from the start of HS-IMRT, with a 6-month and 1-year survival rate of 71.4% and 38.1%, respectively. Karnofsky performance status was a significant prognostic factor of OS as tested by univariate and multivariate analysis. Re-operation rate was 4.8% for radiation necrosis. No other acute or late toxicity Grade 3 or higher was observed.
  
  
  CONCLUSIONS
  This is the first prospective study of biologic imaging optimized HS-IMRT in recurrent GBM. HS-IMRT with PET data seems to be well tolerated and resulted in a median survival time of 11 months after HS-IMRT.
authors.affiliation: Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Gifu, Japan. kz-surg.21@gero-hp.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Miwa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Matsuo
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Ogawa
authors.forename: Jun
authors.initials: J
authors.lastname: Shinoda
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Jitsuhiro
authors.initials: J
authors.lastname: Yamada
authors.forename: Hirohito
authors.initials: H
authors.lastname: Yano
authors.forename: Toru
authors.initials: T
authors.lastname: Iwama
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D002250:Carbon Radioisotopes; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008715:Methionine; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy*; D049268:Positron-Emission Tomography; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D016634:Radiosurgery; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D008715:Methionine