High-Grade Glioma Radiation Therapy and Reirradiation Treatment Planning Using Translocator Protein Positron Emission Tomography With 18F-GE-180

Daniel Felix Fleischmann; Marcel Büttner; Marcus Unterrainer; Stefanie Corradini; Barbara Zollner; Jan Hofmaier; Raphael Bodensohn; Niklas Thon; Claus Belka; Peter Bartenstein; Nathalie L Albert; Maximilian Niyazi

doi:10.1016/j.adro.2023.101185

High-Grade Glioma Radiation Therapy and Reirradiation Treatment Planning Using Translocator Protein Positron Emission Tomography With ¹⁸F-GE-180

Adv Radiat Oncol. 2023 Jan 26;8(3):101185. doi: 10.1016/j.adro.2023.101185. eCollection 2023 May-Jun.

Authors

Daniel Felix Fleischmann^{1

2

3}, Marcel Büttner¹, Marcus Unterrainer⁴, Stefanie Corradini¹, Barbara Zollner¹, Jan Hofmaier¹, Raphael Bodensohn¹, Niklas Thon⁵, Claus Belka^{1

2}, Peter Bartenstein^{2

4}, Nathalie L Albert^{2

4}, Maximilian Niyazi^{1

2}

Affiliations

¹ Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
² German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
³ German Cancer Research Center (DKFZ), Heidelberg, Germany.
⁴ Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.
⁵ Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany.

Abstract

Purpose: Translocator protein (TSPO) positron emission tomography (PET) using ¹⁸F-GE-180 shows high tumor-to-brain contrast in high-grade glioma (HGG), even in areas without magnetic resonance imaging (MRI) contrast enhancement. Until now, the benefit of ¹⁸F-GE-180 PET in primary radiation therapy (RT) and reirradiation (reRT) treatment planning for patients with HGG has not been assessed.

Methods and materials: The possible benefit of ¹⁸F-GE-180 PET in RT and reRT planning was retrospectively evaluated through post hoc spatial correlations of PET-based biological tumor volumes (BTVs) with conventional MRI-based consensus gross tumor volumes (cGTVs). To find the ideal threshold for BTV definition in RT and reRT treatment planning, tumor-to-background activity thresholds of 1.6, 1.8, and 2.0 were applied. Spatial overlap of PET- and MRI-based tumor volumes was measured by the Sørensen-Dice coefficient (SDC) and the conformity index (CI). Additionally, the minimal margin to include the entire BTV into the expanded cGTV was determined.

Results: Thirty-five primary RT and 16 reRT cases were examined. BTV1.6, BTV1.8, and BTV2.0 were significantly larger than corresponding cGTV volumes in primary RT (median volumes: 67.4, 50.7, and 39.1, respectively, vs 22.6 cm³; P < .001, P < .001, and P = .017, respectively; Wilcoxon test) and reRT cases (median volumes: 80.5, 55.0, and 41.6, respectively, vs 22.7 cm³; P = .001, P = .005, and P = .144, respectively; Wilcoxon test). BTV1.6, BTV1.8, and BTV2.0 showed low but increasing conformity with cGTVs in the primary RT (SDC: 0.51, 0.55, and 0.58, respectively; CI: 0.35, 0.38, and 0.41, respectively) and reRT setting (SDC: 0.38, 0.40, and 0.40, respectively; CI: 0.24, 0.25, and 0.25, respectively). The minimal margin required to include the BTV within the cGTV was significantly smaller in the RT versus the reRT setting for thresholds 1.6 and 1.8 but not significantly different for threshold 2.0 (median margin: 16, 12, and 10, respectively, vs 21.5, 17.5, and 13 mm, respectively; P = .007, P = .031, and P = .093, respectively; Mann-Whitney U test).

Conclusions: ¹⁸F-GE-180 PET provides valuable information in RT treatment planning for patients with HGG. ¹⁸F-GE-180-based BTVs with a threshold of 2.0 were most consistent in primary and reRT.