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Integration of PET-imaging into radiotherapy treatment planning for low-grade meningiomas improves outcome

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Abstract

Purpose

Meningiomas have an excellent survival prognosis, and radiotherapy (RT) is a central component of interdisciplinary treatment. During treatment planning, the definition of the target volume remains challenging using MR and CT imaging alone. This is the first study to analyze the impact of additional PET-imaging on local control (LC) and overall survival (OS) after high-precision RT.

Methods

We analyzed 339 meningiomas treated between 2000 and 2018. For analyses, we divided the patients in low-grade (n = 276) and high-grade (n = 63) cases. We performed RT in an adjuvant setting due to subtotal resection or later due to recurrent tumor growth. The target volumes were delineated based on diagnostic CT and MRI and, if available, additional PET-imaging (low-grade: n = 164, 59.4%; high-grade: n = 39, 61.9%) with either 68Ga-Dotanoc/Dotatoc, 18F-fluoroethyltyrosine or 11C-methionine tracer. Patients were treated with fractionated stereotactic RT with a median total dose and dose per fraction of 54 Gy and 1.8 Gy, respectively.

Results

Median follow-up was 5.6 years. For low-grade meningiomas, mean OS was 15.6 years and mean LC was 16.9 years; for high-grade cases mean OS was 11.6 years, and mean LC was 11.1 years. In univariate analyses, PET-imaging had a significant impact on OS (p = 0.035) and LC (p = 0.041) for low-grade meningiomas and remained significant (p = 0.015) for LC in the multivariate analysis. For high-grade cases, PET did not influence both OS and LC. Further prognostic factors could be identified.

Conclusions

For low-grade meningiomas, we showed that the addition of PET-imaging for target volume definition led to a significantly enhanced LC. Thus, PET improves the detection of tumor cells and helps distinguish between healthy tissue and meningioma tissue, especially during the treatment planning process.

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Authors and Affiliations

  1. Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany

    Kerstin A. Kessel, Hanna Fischer, Theresa Voglhuber, Christian Diehl, Christoph Straube & Stephanie E. Combs

  2. Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany

    Kerstin A. Kessel & Stephanie E. Combs

  3. Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Munich, Germany

    Kerstin A. Kessel, Christian Diehl, Christoph Straube & Stephanie E. Combs

  4. Department of Nuclear Medicine, Technical University of Munich (TUM), Ismaninger Straße, 22, Munich, Germany

    Wolfgang Weber & Igor Yakushev

  5. Department of Neuroradiology, Technical University of Munich (TUM), Ismaninger Straße, 22, Munich, Germany

    Claus Zimmer & Benedikt Wiestler

  6. Department of Neurosurgery, Technical University of Munich (TUM), Ismaninger Straße, 22, Munich, Germany

    Jens Gempt & Bernhard Meyer

Authors
  1. Kerstin A. Kessel
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  2. Wolfgang Weber
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  12. Stephanie E. Combs
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Corresponding author

Correspondence to Kerstin A. Kessel.

Ethics declarations

The local ethics committee of the Medical Faculty of the Technical University Munich (TUM) approved the study, vote number 434/15. This study is registered under the open science framework: DOI 10.17605/OSF.IO/RYX9D.

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The authors declare that they have no conflict of interest.

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Kessel, K.A., Weber, W., Yakushev, I. et al. Integration of PET-imaging into radiotherapy treatment planning for low-grade meningiomas improves outcome. Eur J Nucl Med Mol Imaging 47, 1391–1399 (2020). https://doi.org/10.1007/s00259-019-04591-2

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