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  • Blakaj, Dukagjin  (5)
  • 2020-2024  (5)
  • 1
    Online Resource
    Online Resource
    RADT-35. A PROSPECTIVE REGISTRY STUDY OF 68GA-DOTATATE PET INCORPORATION INTO TREATMENT PLANNING OF INTRACRANIAL MENINGIOMAS
    Oxford University Press (OUP) ; 2022
    In:  Neuro-Oncology Vol. 24, No. Supplement_7 ( 2022-11-14), p. vii57-vii57
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 24, No. Supplement_7 ( 2022-11-14), p. vii57-vii57
    Abstract: The current standard for meningioma radiation planning involves MRI-based image guidance. SSTR ligands such as 68Ga-DOTATATE are being explored for meningioma radiotherapy treatment planning due to universal expression of somatostatin receptor 1/2 in meningioma tissue. We hypothesize that 68Ga-DOTATATE PET utilization can reduce the risk of local failure (LF) through precise radiation planning and may also suggest that patients who have local PET avidity after a perceived GTR may be poor observation candidates. METHODS A single institution prospective registry study was created and included intracranial meningioma patients who received a 68Ga-DOTATATE PET scan to assist with radiation oncologist decision-making. These were ordered for all meningioma patients as a departmental standard. Patients who received a PET scan from 1/1/2018-2/25/2022 were eligible for inclusion. RESULTS 60 patients were treated in this prospective registry. 22%, 72%, and 7% were World Health Organization (WHO) high, intermediate, and low-risk, respectively. After completing their PET scan, 48, 11, and 1 patient(s) proceeded with RT, observation, or redo craniotomy. The median follow up was 16 months (IQR 8.3-23.1). 3 patients (5%) experienced LF between 9.2-28.5 months after diagnosis. 2 patients with LF had PET-avid disease in their post-operative cavity and elected for observation prior to recurrence, and 1 high-risk patient with multifocal disease experienced LF 2 years after a second radiation course and multiple previous recurrences. LF rates after radiation were 0%, 0%, and 8% in the low, intermediate, and high-risk cohorts, respectively. There were no Grade 3 or higher toxicities attributed to PET-guided radiation. CONCLUSION This is the largest known population of intracranial meningioma patients followed by physicians who utilized 68Ga-DOTATATE PET guided therapy. Only 1 patient experienced LF after receiving PET-guided radiation therapy, likely due to a radioresistant histology. Incorporating 68Ga-DOTATATE PET into future trials may assist with clinician decision-making and improve patient outcomes.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/noac209.225
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2094060-9
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  • 2
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    Online Resource
    68Ga-DOTATATE PET-Based Radiation Contouring Creates More Precise Radiation Volumes for Patients With Meningioma
    Elsevier BV ; 2022
    In:  International Journal of Radiation Oncology*Biology*Physics Vol. 113, No. 4 ( 2022-07), p. 859-865
    Details
    In: International Journal of Radiation Oncology*Biology*Physics, Elsevier BV, Vol. 113, No. 4 ( 2022-07), p. 859-865
    Type of Medium: Online Resource
    ISSN: 0360-3016
    URL: Article
    DOI: 10.1016/j.ijrobp.2022.04.009
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 1500486-7
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  • 3
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    NIMG-62. 68(GA)DOTATATE PET-BASED RADIATION CONTOURING CREATES SMALLER AND MORE PRECISE RADIATION VOLUMES FOR MENINGIOMA PATIENTS
    Oxford University Press (OUP) ; 2021
    In:  Neuro-Oncology Vol. 23, No. Supplement_6 ( 2021-11-12), p. vi143-vi143
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 23, No. Supplement_6 ( 2021-11-12), p. vi143-vi143
    Abstract: Radiation treatment planning for meningiomas conventionally involves MRI contrast enhanced images to define residual tumor. However, the gross tumor volume may be difficult to delineate for patients with a meningioma in the skull base, sagittal sinus, or post resection. Advanced PET imaging using 68(GA)DOTATATE PET, which has been shown to be more sensitive and specific than MRI imaging, can be used for target volume delineation in these circumstances. We hypothesize that 68(GA)DOTATATE PET scan-based treatment planning will lead to smaller radiation volumes and will detect additional areas of disease compared to standard MRI alone. METHODS Our data evaluated retrospective, deidentified, and blinded gross tumor volume (GTV) contour delineation with 7 CNS specialists (3 neuroradiologists, 4 CNS radiation oncologists) for 26 patients diagnosed with a meningioma who received both a 68(GA)DOTATATE PET and an MRI for radiation treatment planning. Both the MRI and the PET were non-sequentially contoured by each physician for each patient. RESULTS The mean MRI volume for each physician ranged from 24.14-35.52 ccs. The mean PET volume for each physician ranged from 10.59-20.54 ccs. The PET volumes were significantly smaller for 6 out of the 7 physicians. In addition, 7/26 (27%) patients had new non-adjacent areas contoured on PET by at least 6 of the 7 physicians that were not contoured by these physicians on the corresponding MRI. These new areas would not have been in the traditional MRI based volumes. CONCLUSION Our study supports that 68(GA)DOTATATE PET imaging can help radiation oncologist create smaller and more precise radiation treatment volumes. Utilization of 68(GA)DOTATATE PET may find undetected areas of disease which in turn can improve local control and progression free survival. 68(GA)DOTATATE PET guided treatment planning should be studied prospectively.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/noab196.560
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 4
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    Online Resource
    RADT-05. VOLUMETRIC MODULATED ARC THERAPY CRANIOSPINAL IRRADIATION UTILIZING A VERTEBRAL BODY SPARING APPROACH: A DOSIMETRIC ANALYSIS
    Oxford University Press (OUP) ; 2022
    In:  Neuro-Oncology Vol. 24, No. Supplement_7 ( 2022-11-14), p. vii49-vii49
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 24, No. Supplement_7 ( 2022-11-14), p. vii49-vii49
    Abstract: Craniospinal irradiation (CSI) is indicated for adult patients diagnosed with leptomeningeal disease (LMD). Proton-based vertebral-body-sparing (VBS) CSI has been explored with pediatric patients to minimize hematologic toxicity; however, utilization of VBS in an adult population is limited. We hypothesize that VBS-CSI utilizing volumetric modulated arc therapy (VMAT) will effectively reduce vertebral body dose while minimizing dose to surrounding organs-at-risk (OAR) for adult patients with LMD. METHODS Ten adult patients with LMD received CSI, 30 Gy in 10 fractions. These patients were initially treated with a variety of VMAT and IMRT treatment techniques. These patients were then retrospectively replanned using VMAT VBS-CSI. For their VBS-CSI replan, full VMAT arcs for the brain fields matched to two spine isocenters for the upper and lower spine were created utilizing limited posterior arcs. The PTV was created with margins of 3mm uniformly around the brain contour and 7mm around the spinal canal. To further decrease the vertebral body dose, an avoid entry and exit contour was created. This structure was a margin on the PTV anteriorly designed to carve dose out of the vertebral bodies while still maintaining coverage to the PTV. RESULTS All 10 patients had a reduction in vertebral body dose with VMAT VBS-CSI when compared to their initial plan. The mean vertebral dose for the VBS-CSI plans had an average reduction of 33% compared to the initial plans. The mean dose to the small bowel and esophagus were reduced by 46% and 67%, respectively. CONCLUSIONS VBS-CSI may be utilized to minimize dose to surrounding OARs and vertebral bodies. In this study, VMAT VBS-CSI led to significant reductions in vertebral body dose while also minimizing dose to other OARs. VMAT VBS-CSI may be an acceptable alternative to proton-based VBS-CSI in an adult population with LMD. Prospective evaluation is warranted.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/noac209.195
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2094060-9
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  • 5
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    RADT-12. PRE- AND POST-OPERATIVE RADIATION TREATMENT PLANNING FOR PATIENTS RECEIVING STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES: A VOLUMETRIC ANALYSIS
    Oxford University Press (OUP) ; 2022
    In:  Neuro-Oncology Vol. 24, No. Supplement_7 ( 2022-11-14), p. vii51-vii51
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 24, No. Supplement_7 ( 2022-11-14), p. vii51-vii51
    Abstract: Pre-operative stereotactic radiosurgery (SRS) has emerged as a recent treatment option to treat large or symptomatic brain metastases. Compared to post-operative SRS, pre-operative treatment may reduce rates of radiation necrosis (RN) and meningeal disease through treating a smaller treatment volume and by preventing post-operative tumor seeding. We hypothesize that pre-operative radiation volumes will be smaller than post-operative volumes, which in turn may lead to a decreased treatment morbidity. METHODS A retrospective analysis was conducted and patients who had surgical resection and post-operative SRS or fractionated stereotactic radiosurgery (FSRT) for a posterior fossa brain metastasis were eligible for inclusion. Both pre-operative and post-operative MRIs were required to allow for accurate radiation target delineation. A pre-operative tumor volume was added for each patient, and the post-operative clinical treatment volume (CTV) used for radiation treatment was included. Pre-operative tumor and post-operative cavity volumes were compared using Wilcoxon signed rank test. RESULTS 28 patients who received post-operative SRS or FSRT from 1/1/2016-12/31/2020 were included in this analysis. The mean pre-operative tumor volume was 14.9 ccs, and the mean post-operative CTV was 21.0 ccs (p & lt; 0.01). 75% of patients had a smaller initial tumor size compared to the post-operative CTV used for radiation treatment planning. For patients with at least 4 follow up MRIs (n = 8), the size of the post-operative cavity progressively decreased with a mean initial cavity volume of 18.9 ccs and mean follow up volumes of 8.1, 7.1, 6.9, and 6.2 ccs. CONCLUSIONS In this study evaluating patients who received post-operative SRS, the pre-operative tumor volume was lower than the post-operative CTV for most patients. Previous studies including PROPS-BM have shown how pre-operative treatment may reduce the risk of RN because smaller radiation volumes are used. Pre-operative radiosurgery for patients with brain metastases requires prospective validation.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/noac209.202
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2094060-9
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