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18F-FET-PET-Based Dose Painting by Numbers with Protons

18F-FET-PET-basiertes „dose painting by numbers“ mit Protonen

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Strahlentherapie und Onkologie Aims and scope Submit manuscript

Purpose:

To investigate the potential of 18F-fluoroethyltyrosine-positron emission tomography-(18F-FET-PET-)based dose painting by numbers with protons.

Material and Methods:

Due to its high specificity to brain tumor cells, FET has a high potential to serve as a target for dose painting by numbers. Biological image-based dose painting might lead to an inhomogeneous dose prescription. For precise treatment planning of such a prescribed dose, an intensity-modulated radiotherapy (IMRT) algorithm including a Monte Carlo dose-calculation algorithm for spot-scanning protons was used. A linear tracer uptake to dose model was used to derive a dose prescription from the 18F-FET-PET. As a first investigation, a modified modulation transfer function (MTF) of protons was evaluated and compared to the MTF of photons. In a clinically adapted planning study, the feasibility of 18F-FET-PET-based dose painting with protons was demonstrated using three patients with glioblastome multiforme. The resulting dose distributions were evaluated by means of dose-difference and dose-volume histograms and compared to IMRT data.

Results:

The MTF for protons was constantly above that for photons. The standard deviations of the dose differences between the prescribed and the optimized dose were smaller in case of protons compared to photons. Furthermore, the escalation study showed that the doses within the subvolumes identified by biological imaging techniques could be escalated remarkably while the dose within the organs at risk was kept at a constant level.

Conclusion:

The presented investigation fortifies the feasibility of 18F-FET-PET-based dose painting with protons.

Ziel:

Untersuchung der Möglichkeiten von 18F-Fluoroethyltyrosin-Positronenemissionstomographie-(18F-FET-PET-)basiertem „dose painting by numbers“ mit Protonen.

Material und Methodik:

Aufgrund seiner hohen Spezifität bei Hirntumoren ist FET potentiell gut als Marker für „dose painting by numbers“ geeignet. „Dose painting by numbers“ auf der Grundlage biologischer Bildgebung könnte zu einer heterogenen Dosisverschreibung führen. Für die Planung einer derartigen Dosisverschreibung wurde ein IMRT-Algorithmus (intensitätsmodulierte Radiotherapie) mit einem Monte-Carlo-Dosisalgorithmus verwendet. Ein lineares Traceranreicherung-zu-Dosis-Modell wurde verwendet, um die Dosisverschreibung von der 18F-FET-PET abzuleiten. Zur Untersuchung der Modulationsfähigkeit des Systems wurde eine modifizierte Modulationsübertragungsfunktion (MTF [„modulation transfer function“]) für Protonen ausgewertet und mit der MTF für Photonen verglichen. In einer klinisch adaptierten Planungsstudie wurden die Möglichkeiten von 18F-FET-basiertem „dose painting“ anhand dreier Patienten mit Glioblastoma multiforme demonstriert. Die geplanten Dosisverteilungen wurden mittels Differenzdosis- und Dosis-Volumen-Histogrammen ausgewertet und mit IMRT-Daten verglichen.

Ergebnisse:

Die MTF für Protonen war stets oberhalb der von Photonen. Die Standardabweichungen der Dosisdifferenzen zwischen vorgegebener und optimierter Dosisverteilung waren im Fall von Protonen kleiner als bei Photonen. Zusätzlich zeigte die Eskalationsstudie, dass die Dosis innerhalb durch biologische Bildgebung definierter Subvolumina deutlich eskaliert werden konnte, während gleichzeitig die Dosis innerhalb der Risikoorgane konstant gehalten werden konnte.

Schlussfolgerung:

Die vorgestellten Untersuchungen bestätigen die Durchführbarkeit von 18F-FET-PET-basiertem „dose painting“ mit Protonen und weisen auf deren Potential zur Dosiseskalation hin.

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Authors and Affiliations

  1. Department of Radiotherapy, University of Regensburg, Regensburg, Germany

    Mark Rickhey, Zdenek Morávek, Oliver Koelbl & Ludwig Bogner

  2. Department of Nuclear Medicine, University of Regensburg, Regensburg, Germany

    Christoph Eilles

  3. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93049, Regensburg, Germany

    Mark Rickhey

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  1. Mark Rickhey
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  2. Zdenek Morávek
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  3. Christoph Eilles
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  4. Oliver Koelbl
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  5. Ludwig Bogner
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Correspondence to Mark Rickhey.

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Rickhey, M., Morávek, Z., Eilles, C. et al. 18F-FET-PET-Based Dose Painting by Numbers with Protons. Strahlenther Onkol 186, 320–326 (2010). https://doi.org/10.1007/s00066-010-2014-8

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  • DOI: https://doi.org/10.1007/s00066-010-2014-8

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