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Article Abstract
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, F-FET-PET imaging can better visualize infiltrative components, improving target definition. This study investigates the role of F-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 F-FET-PET, on which Biological Tumor Volume (BTV) was delineated, and T1Gd, on which Gross Tumor Volume (GTV) and Clinical tumor volume (CTV) 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 and the non-overlapping BTV-GTV volumes were significantly larger than GTV and non-overlapping GTV-BTV (P < 0.001), but significantly smaller than the CTV (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 and WM in non-overlapping BTV (slope = 0.36, R = 0.36;P < 0.001) and a correlation with gray matter (GM) in non-overlapping BTV (slope = -0.15, R = 0.11;P < 0.05). Recurrence after reirradiation was significantly higher within BTV than GTV (P < 0.001). The ratio of the GTV which recurred was significantly higher than the non-overlapping BTV (P < 0.001).
Conclusion: Our results suggest that F-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 F-FET-PET.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879608 | PMC |
| http://dx.doi.org/10.1016/j.ctro.2025.100931 | DOI Listing |
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