68Ga-DOTATATE PET-Based Radiation Contouring Creates More Precise Radiation Volumes for Patients With Meningioma

Perlow, Haley K.; Siedow, Michael; Gokun, Yevgeniya; McElroy, Joseph P.; Matsui, Jennifer K.; Zoller, Wesley; Beyer, Sasha; Arnett, A.L.H.; Blakaj, Dukagjin; Boulter, Daniel; Fritz, Joel; Miller, Eric J.; Raval, Raju R.; Bovi, Joseph; Palmer, Joshua D.

doi:10.1016/j.ijrobp.2022.04.009

Cited by 17 publications

(9 citation statements)

References 17 publications

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“…In general, IOV was reduced significantly when adding PET information, which is in agreement with former studies by MacLean et al [ 12 ] and Perlow et al [ 11 ]. The reduction in IOV was exemplified by the higher Dice coefficient found for the MRI + PET-based planning compared to the Dice coefficient found for MRI-only-based planning.…”

Section: Discussionsupporting

confidence: 92%

“…Similar to previous studies, it was observed that additional information provided by SSTR PET changed the treatment planning tumor volumes significantly [ 8 , 9 , 11 , 13 , 16 ]. Although the average metabolic tumor volume was increased with this additional image information, there were fewer outliers, such as an MRI contour with a substantially overestimated volume of up to 95.1 cm 3 in one case of this study.…”

Section: Discussionsupporting

confidence: 84%

“…Previous studies showed that the additional information gained by the SSTR PET did not only improve sensitivity in the diagnosis of meningiomas compared to MRI alone but also allowed a more precise tumor delineation than when using only contrast-enhanced MRI. In particular, in the case of osseous tumor infiltration or for lesions located at the skull base, as well as for therapy planning subsequent to prior therapy, SSTR PET helps to discriminate tumors from other surrounding tissues [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…The additional information gained by SSTR PET is expected to facilitate tumor delineation, thus, also reducing the inter-observer variability (IOV). However, although some studies were conducted on the influence of SSTR PETs with respect to the IOV, the overall level of evidence about the asset of including SSTR PET in the therapy planning for meningioma is limited [ 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of SSTR PET on Inter-Observer Variability of Target Delineation of Meningioma and the Possibility of Using Threshold-Based Segmentations in Radiation Oncology

Kriwanek

Ulbrich

Lechner

et al. 2022

Cancers

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Aim: The aim of this study was to assess the effects of including somatostatin receptor agonist (SSTR) PET imaging in meningioma radiotherapy planning by means of changes in inter-observer variability (IOV). Further, the possibility of using threshold-based delineation approaches for semiautomatic tumor volume definition was assessed. Patients and Methods: Sixteen patients with meningioma undergoing fractionated radiotherapy were delineated by five radiation oncologists. IOV was calculated by comparing each delineation to a consensus delineation, based on the simultaneous truth and performance level estimation (STAPLE) algorithm. The consensus delineation was used to adapt a threshold-based delineation, based on a maximization of the mean Dice coefficient. To test the threshold-based approach, seven patients with SSTR-positive meningioma were additionally evaluated as a validation group. Results: The average Dice coefficients for delineations based on MRI alone was 0.84 ± 0.12. For delineation based on MRI + PET, a significantly higher dice coefficient of 0.87 ± 0.08 was found (p < 0.001). The Hausdorff distance decreased from 10.96 ± 11.98 mm to 8.83 ± 12.21 mm (p < 0.001) when adding PET for the lesion delineation. The best threshold value for a threshold-based delineation was found to be 14.0% of the SUVmax, with an average Dice coefficient of 0.50 ± 0.19 compared to the consensus delineation. In the validation cohort, a Dice coefficient of 0.56 ± 0.29 and a Hausdorff coefficient of 27.15 ± 21.54 mm were found for the threshold-based approach. Conclusions: SSTR-PET added to standard imaging with CT and MRI reduces the IOV in radiotherapy planning for patients with meningioma. When using a threshold-based approach for PET-based delineation of meningioma, a relatively low threshold of 14.0% of the SUVmax was found to provide the best agreement with a consensus delineation.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of SSTR PET on Inter-Observer Variability of Target Delineation of Meningioma and the Possibility of Using Threshold-Based Segmentations in Radiation Oncology

Kriwanek

Ulbrich

Lechner

et al. 2022

Cancers

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“…Some have begun to investigate the use of SSTR2A based molecular imaging to guide radiation planning and target delineation [ 80 , 81 ], demonstrating the feasibility of reducing target size using customized margins as determined by DOTATATE PET. In light of the propensity of meningioma to infiltrate nearby dura and bone, care should be taken against omitting microscopic residual disease which is below the DOTATATE PET detection limit, which is as yet not well defined.…”

Section: Future Directionsmentioning

confidence: 99%

Radiotherapy for meningiomas

et al. 2022

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Meningiomas are the most common primary central nervous system neoplasm. Despite promising recent progress in elucidating the genomic landscape and underlying biology of these histologically, molecularly, and clinically diverse tumors, the mainstays of meningioma treatment remain maximal safe resection and radiation therapy. The aim of this review of meningioma radiotherapy is to provide a concise summary of the history, current evidence, and future for application of radiotherapy in meningioma treatment.

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