Abstract
Purpose: In-field high-grade glioma (HGG) recurrence is a common challenge with limited treatment options, including re-irradiation. The radiotracer 3,4-dihydroxy-6-[18F]-fluoro-l-phenylalanine (18F-DOPA) crosses the blood brain barrier and demonstrates high uptake in tumor, but low uptake in normal tissue. This study investigated whether 18F-DOPA positron emission tomography (PET) and MRI guided re-irradiation for recurrent HGG may improve progression free survival (PFS). Methods: Adults with recurrent or progressive HGG previously treated with radiation were eligible. The primary endpoint was a 20% improvement from the historical control PFS at 3 months (PFS3) of 20% with systemic therapy alone. Re-RT dose was 35 Gy in 10 fractions. The target volume was MRI T1 contrast-enhancement defined tumor plus 18F-DOPA PET defined tumor. Results: Twenty patients completed treatment per protocol. Diagnosis was most commonly glioblastoma, IDH-wildtype (60%). MRI-defined volumes were expanded by a median 43% (0–436%) by utilizing 18F-DOPA PET. PFS3 was 85% (95% CI 63.2–95.8%), meeting the primary endpoint of PFS3 ≥ 40%. With 9.7 months median follow-up, 17 (85%) had progressed and 15 (75%) had died. Median OS from re-RT was 8.8 months. Failure following re-RT was within both the MRI and PET tumor volumes in 75%, MRI only in 13%, PET only in 0%, and neither in 13%. Four (20%) patients experienced grade 3 toxicity, including CNS necrosis (n = 2, both asymptomatic with bevacizumab initiation for radiographic findings), seizures (n = 1), fatigue (n = 1), and nausea (n = 1). No grade 4–5 toxicities were observed. Conclusion: 18F-DOPA PET-guided re-irradiation for progressive high-grade glioma appears safe and promising for further investigation.
Original language | English (US) |
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Pages (from-to) | 323-330 |
Number of pages | 8 |
Journal | Journal of neuro-oncology |
Volume | 158 |
Issue number | 3 |
DOIs | |
State | Published - Jul 2022 |
Keywords
- Functional imaging
- Glioblastoma
- High grade glioma
- PET
- Radiation therapy
- Re-irradiation
ASJC Scopus subject areas
- Oncology
- Neurology
- Clinical Neurology
- Cancer Research