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Open Access Highly Accessed Research

[68Ga]-DOTATOC-PET/CT for meningioma IMRT treatment planning

Barbara Gehler1, Frank Paulsen1, Mehmet Ö Öksüz38, Till-Karsten Hauser4, Susanne M Eschmann6, Roland Bares3, Christina Pfannenberg5, Michael Bamberg1, Peter Bartenstein7, Claus Belka2 and Ute Ganswindt2*

Author Affiliations

1 Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany

2 Department of Radiation Oncology, LMU München, Marchioninistr. 15, 81377 München, Germany

3 Department of Nuclear Medicine, University of Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany

4 Department of Neuroradiology, University of Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany

5 Department of Radiology, University of Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany

6 Medizinisches Versorgungszentrum Nuklearmedizin, Marienhospital Stuttgart, Böheimstr 37, 70199 Stuttgart, Germany

7 Department of Nuclear Medicine, LMU München, Marchioninistr 15, 81377 München, Germany

8 Department of Radiology, University Hospital Basel, Petersgraben 4, CH 4031 Basel, Switzerland

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Radiation Oncology 2009, 4:56  doi:10.1186/1748-717X-4-56

Published: 18 November 2009

Abstract

Purpose

The observation that human meningioma cells strongly express somatostatin receptor (SSTR 2) was the rationale to analyze retrospectively in how far DOTATOC PET/CT is helpful to improve target volume delineation for intensity modulated radiotherapy (IMRT).

Patients and Methods

In 26 consecutive patients with preferentially skull base meningioma, diagnostic magnetic resonance imaging (MRI) and planning-computed tomography (CT) was complemented with data from [68Ga]-DOTA-D Phe1-Tyr3-Octreotide (DOTATOC)-PET/CT. Image fusion of PET/CT, diagnostic computed tomography, MRI and radiotherapy planning CT as well as target volume delineation was performed with OTP-Masterplan®. Initial gross tumor volume (GTV) definition was based on MRI data only and was secondarily complemented with DOTATOC-PET information. Irradiation was performed as EUD based IMRT, using the Hyperion Software package.

Results

The integration of the DOTATOC data led to additional information concerning tumor extension in 17 of 26 patients (65%). There were major changes of the clinical target volume (CTV) which modify the PTV in 14 patients, minor changes were realized in 3 patients. Overall the GTV-MRI/CT was larger than the GTV-PET in 10 patients (38%), smaller in 13 patients (50%) and almost the same in 3 patients (12%). Most of the adaptations were performed in close vicinity to bony skull base structures or after complex surgery. Median GTV based on MRI was 18.1 cc, based on PET 25.3 cc and subsequently the CTV was 37.4 cc. Radiation planning and treatment of the DOTATOC-adapted volumes was feasible.

Conclusion

DOTATOC-PET/CT information may strongly complement patho-anatomical data from MRI and CT in cases with complex meningioma and is thus helpful for improved target volume delineation especially for skull base manifestations and recurrent disease after surgery.