REVIEW  MOLECULAR PET IMAGING IN ADAPTIVE RADIOTHERAPY 

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2018 December;62(4):337-48

DOI: 10.23736/S1824-4785.18.03116-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Molecular PET imaging in adaptive radiotherapy: brain

Guillaume PEYRAGA ¹, Nesrine ROBAINE ², Jonathan KHALIFA ^{1, 3}, Elizabeth COHEN-JONATHAN-MOYAL ^{1, 3}, Pierre PAYOUX ⁴, Anne LAPRIE ^{1, 3} ✉

¹ Department of Radiation Therapy, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France; ² Department of Nuclear Medicine, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France; ³ Paul Sabatier University, Toulouse III, Toulouse, France; ⁴ Department of Nuclear Medicine, Purpan University Hospital Center, Toulouse, France

INTRODUCTION: Owing to their heterogeneity and radioresistance, the prognosis of primitive brain tumors, which are mainly glial tumors, remains poor. Dose escalation in radioresistant areas is a potential issue for improving local control and overall survival. This review focuses on advances in biological and metabolic imaging of brain tumors that are proving to be essential for defining tumor target volumes in radiation therapy (RT) and for increasing the use of DPRT (dose painting RT) and ART (adaptative RT), to optimize dose in radio-resistant areas.
EVIDENCE ACQUISITION: Various biological imaging modalities such as PET (hypoxia, glucidic metabolism, protidic metabolism, cellular proliferation, inflammation, cellular membrane synthesis) and MRI (spectroscopy) may be used to identify these areas of radioresistance. The integration of these biological imaging modalities improves the diagnosis, prognosis and treatment of brain tumors.
EVIDENCE SYNTHESIS: Technological improvements (PET and MRI), the development of research, and intensive cooperation between different departments are necessary before using daily metabolic imaging (PET and MRI) to treat patients with brain tumors.
CONCLUSIONS: The adaptation of treatment volumes during RT (ART) seems promising, but its development requires improvements in several areas and an interdisciplinary approach involving radiology, nuclear medicine and radiotherapy. We review the literature on biological imaging to outline the perspectives for using DPRT and ART in brain tumors.

KEY WORDS: Brain neoplasms - Glioma - Positron-emission tomography - Radiotherapy