A Biologically Adapted Dose-Escalation Approach, Demonstrated for 18F-FET-PET in Brain Tumors

Abstract

Assuming that regions with high tracer uptake can be interpreted as target for radiotherapy, (18)F-FET-PET-based "dose painting by numbers" applied to brain tumors is a feasible approach. The dose, and therefore potentially the chance of tumor control, can be enhanced. The proposed model can easily be transferred to other tracers and tumor entities.

Integrated boost IMRT with FET-PET-adapted local dose escalation in glioblastomas

“…In a previous study, Grosu et al [8] observed a significant survival benefit in re- current high-grade gliomas that were reirradiated on the basis of combined MRI and amino acid PET/SPECT compared to MRI-based treatment alone. The feasibility of a FET-based dose painting could be demonstrated in our own planning study [17] and as well a study by Rickhey et al [20,21].…”

Methods for estimating the site of origin of locoregional recurrence in head and neck squamous cell carcinoma

“…Although recurrences could be multifocal, an analysis of recurrence pattern based on these methods may be of value to derive or validate potential dose painting strategies [10,16].…”

The Use of FDG-PET to Target Tumors by Radiotherapy

“…Many high-grade gliomas show intratumor heterogeneity and PET could be used to define tumor regions being at high risk for recurrence. Regions with abnormal tracer uptake (reported for FDG or FET [ 18 F-fluoroethyltyrosine]) are at risk for first tumor progression and could therefore be a target for dose escalation [59,65,79]. Areas of FET uptake on FET-PET-CT for radiotherapy planning were being observed up to 20 mm outside the area of gadolinium enhancement on MRI [79].…”