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@ARTICLE{Piroth:810995,
      author       = {Piroth, Marc D. and Galldiks, Norbert and Pinkawa, Michael
                      and Holy, Richard and Stoffels, Gabriele and Ermert,
                      Johannes and Mottaghy, Felix M. and Shah, N. J. and Langen,
                      Karl-Josef and Eble, Michael J.},
      title        = {{R}elapse patterns after radiochemotherapy of glioblastoma
                      with {FET} {PET}-guided boost irradiation and simulation to
                      optimize radiation target volume},
      journal      = {Radiation oncology},
      volume       = {11},
      number       = {1},
      issn         = {1748-717X},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {FZJ-2016-03533},
      pages        = {87},
      year         = {2016},
      abstract     = {BackgroundO-(2-18 F-fluoroethyl)-L-tyrosine-(FET)-PET may
                      be helpful to improve the definition of radiation target
                      volumes in glioblastomas compared with MRI. We analyzed the
                      relapse patterns in FET-PET after a FET- and MRI-based
                      integrated-boost intensity-modulated radiotherapy (IMRT) of
                      glioblastomas to perform an optimized target volume
                      definition.MethodsA relapse pattern analysis was performed
                      in 13 glioblastoma patients treated with radiochemotherapy
                      within a prospective phase-II-study between 2008 and 2009.
                      Radiotherapy was performed as an integrated-boost
                      intensity-modulated radiotherapy (IB-IMRT). The prescribed
                      dose was 72 Gy for the boost target volume, based on
                      baseline FET-PET (FET-1) and 60 Gy for the MRI-based (MRI-1)
                      standard target volume. The single doses were 2.4 and 2.0
                      Gy, respectively. Location and volume of recurrent tumors in
                      FET-2 and MRI-2 were analyzed related to initial tumor,
                      detected in baseline FET-1. Variable target volumes were
                      created theoretically based on FET-1 to optimally cover
                      recurrent tumor.ResultsThe tumor volume overlap in FET and
                      MRI was poor both at baseline (median 12 $\%;$ range 0–32)
                      and at time of recurrence (13 $\%;$ 0–100). Recurrent
                      tumor volume in FET-2 was localized to 39 $\%$ (12–91) in
                      the initial tumor volume (FET-1). Over the time a shrinking
                      (mean 12 (5–26) ml) and shifting (mean 6 (1–10 mm) of
                      the resection cavity was seen. A simulated target volume
                      based on active tumor in FET-1 with an additional safety
                      margin of 7 mm around the FET-1 volume covered recurrent FET
                      tumor volume (FET-2) significantly better than a
                      corresponding target volume based on contrast enhancement in
                      MRI-1 with a same safety margin of 7 mm (100 $\%$ (54–100)
                      versus 85 $\%$ (0–100); p < 0.01). A simulated
                      planning target volume (PTV), based on FET-1 and additional
                      7 mm margin plus 5 mm margin for setup-uncertainties was
                      significantly smaller than the conventional, MR-based PTV
                      applied in this study (median 160 (112–297) ml versus 231
                      (117–386) ml, p < 0.001).ConclusionsIn this small
                      study recurrent tumor volume in FET-PET (FET-2) overlapped
                      only to one third with the boost target volume, based on
                      FET-1. The shrinking and shifting of the resection cavity
                      may have an influence considering the limited overlap of
                      initial and relapse tumor volume. A simulated target volume,
                      based on FET-1 with 7 mm margin covered 100 $\%$ of relapse
                      volume in median and led to a significantly reduced PTV,
                      compared to MRI-based PTVs. This approach may achieve
                      similar therapeutic efficacy but lower side effects offering
                      a broader window to intensify concomitant systemic treatment
                      focusing distant failures.},
      cin          = {INM-3 / INM-4 / INM-5 / JARA-BRAIN},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-3-20090406 / I:(DE-Juel1)INM-4-20090406 /
                      I:(DE-Juel1)INM-5-20090406 / $I:(DE-82)080010_20140620$},
      pnm          = {573 - Neuroimaging (POF3-573)},
      pid          = {G:(DE-HGF)POF3-573},
      typ          = {PUB:(DE-HGF)16},
      UT           = {WOS:000378576700001},
      pubmed       = {pmid:27342976},
      doi          = {10.1186/s13014-016-0665-z},
      url          = {https://juser.fz-juelich.de/record/810995},
}