基于18F-FET-PET和mri的靶标定义在复发性弥漫性胶质瘤再照射治疗中的比较

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology Pub Date : 2025-02-11 DOI:10.1016/j.ctro.2025.100931

Albert Everard , Daniel Versnel , Veerle Ruijters , Nelleke Tolboom , Marielle Philippens , Tom Snijders , Joost Verhoeff , Szabolcs David , Casper Beijst

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引用次数: 0

摘要

背景与目的复发性胶质瘤再照射的靶区定义通常依赖于t1加权钆增强MRI (T1Gd)，但T1Gd无法捕获胶质瘤浸润。虽然T2 FLAIR和CTV切缘可以解决这一限制，但它们在再照射中的延伸范围仍存在争议，以尽量减少毒性。相比之下，18F-FET-PET成像可以更好地显示浸润成分，提高目标清晰度。本研究通过分析形状差异和灰质组织组成来探讨18F-FET-PET在目标定义中的作用。材料与方法回顾性分析36例复发性胶质瘤患者的资料。这些患者分别接受了18F-FET-PET和T1Gd检查，分别对生物肿瘤体积（BTVPET）和临床肿瘤体积（CTVMRI）进行了描绘。比较两组病灶体积、形状（Hausdorff distance， HD）、质心距离（CoM-D）、组织组成及再发体积。结果btvpet和非重叠BTVPET-GTVMRI的体积明显大于GTVMRI和非重叠gtvpet - btvpet (P <；0.001)，但显著小于CTVMRI (P <；0.001)。中位HD和CoM-D分别为19 mm和6 mm。GTVMRI的白质（WM）比与无重叠BTVPET的WM有相关性(斜率= 0.36,R2 = 0.36;P <；0.001)和非重叠BTVPET与灰质（GM）的相关性(斜率= -0.15,R2 = 0.11;P <；0.05)。再照射后BTVPET复发率明显高于GTVMRI (P <；0.001)。GTVMRI复发率明显高于无重叠BTVPET (P <；0.001)。我们的研究结果表明，18F-FET-PET显示了更完整的胶质瘤浸润程度，建议重新考虑目前在T1Gd-GTV周围使用各向同性CTV边缘的方法，而采用基于18F-FET-PET的各向异性CTV。

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Comparison of 18F-FET-PET- and MRI-based target definition for re-irradiation treatment of recurrent diffuse glioma

Background and purpose

The target area definition for re-irradiation of recurrent glioma typically relies on T1-weighted gadolinium-enhanced MRI (T1Gd), but T1Gd fails to capture glioma infiltration. While T2 FLAIR and CTV margins can address this limitation, their extend in re-irradiation remains debated to minimize toxicity. In contrast, ¹⁸F-FET-PET imaging can better visualize infiltrative components, improving target definition. This study investigates the role of ¹⁸F-FET-PET in target definition by analyzing shape differences and gray-white matter tissue composition.

Material and methods

Retrospective data from 36 patients with recurrent glioma were used. These patients underwent ¹⁸F-FET-PET, on which Biological Tumor Volume (BTV_PET) was delineated, and T1Gd, on which Gross Tumor Volume (GTV_MRI) and Clinical tumor volume (CTV_MRI) were delineated. Lesion volume, shape (Hausdorff distance (HD) and Center of Mass Distance (CoM-D)), tissue composition and re-recurrence volume were compared between the delineations.

Results

BTV_PET and the non-overlapping BTV_PET-GTV_MRI volumes were significantly larger than GTV_MRI and non-overlapping GTV_MRI-BTV_PET (P < 0.001), but significantly smaller than the CTV_MRI (P < 0.001). The median HD and CoM-D were 19 mm and 6 mm. A correlation was found between the white matter (WM) ratio in GTV_MRI and WM in non-overlapping BTV_PET (slope = 0.36, R² = 0.36;P < 0.001) and a correlation with gray matter (GM) in non-overlapping BTV_PET (slope = -0.15, R² = 0.11;P < 0.05). Recurrence after reirradiation was significantly higher within BTV_PET than GTV_MRI (P < 0.001). The ratio of the GTV_MRI which recurred was significantly higher than the non-overlapping BTV_PET (P < 0.001).

Conclusion

Our results suggest that ¹⁸F-FET-PET reveals a more complete extent of glioma’s infiltration, suggesting that the current practice of using isotropic CTV margins around the T1Gd-GTV should be reconsidered in favor of anisotropic CTV based on ¹⁸F-FET-PET.

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