Re-irradiation of Recurrent Glioblastoma Multiforme Using 11C-methionine PET/CT/MRI Image Fusion for Hypofractionated Stereotactic Radiotherapy by Intensity Modulated Radiation Therapy

Radiat Oncol. 2014 Aug 14;9:181. doi: 10.1186/1748-717X-9-181.


Background: This research paper presents a valid treatment strategy for recurrent glioblastoma multiforme (GBM) using hypofractionated stereotactic radiotherapy by intensity modulated radiation therapy (HS-IMRT) planned with 11C-methionine positron emission tomography (MET-PET)/computed tomography (CT)/magnetic resonance imaging (MRI) fusion.

Methods: Twenty-one patients with recurrent GBM received HS-IMRT planned by MET-PET/CT/MRI. The region of increased amino acid tracer uptake on MET-PET was defined as the gross tumor volume (GTV). The planning target volume encompassed the GTV by a 3-mm margin. Treatment was performed with a total dose of 25- to 35-Gy, given as 5- to 7-Gy daily for 5 days.

Results: With a median follow-up of 12 months, median overall survival time (OS) was 11 months from the start of HS-IMRT, with a 6-month and 1-year survival rate of 71.4% and 38.1%, respectively. Karnofsky performance status was a significant prognostic factor of OS as tested by univariate and multivariate analysis. Re-operation rate was 4.8% for radiation necrosis. No other acute or late toxicity Grade 3 or higher was observed.

Conclusions: This is the first prospective study of biologic imaging optimized HS-IMRT in recurrent GBM. HS-IMRT with PET data seems to be well tolerated and resulted in a median survival time of 11 months after HS-IMRT.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Brain Neoplasms / mortality
  • Brain Neoplasms / radiotherapy*
  • Carbon Radioisotopes
  • Chemotherapy, Adjuvant
  • Combined Modality Therapy
  • Female
  • Glioblastoma / mortality
  • Glioblastoma / radiotherapy*
  • Humans
  • Kaplan-Meier Estimate
  • Magnetic Resonance Imaging
  • Male
  • Methionine
  • Middle Aged
  • Multimodal Imaging / methods*
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / radiotherapy*
  • Positron-Emission Tomography
  • Proportional Hazards Models
  • Radiopharmaceuticals
  • Radiosurgery
  • Radiotherapy Planning, Computer-Assisted / methods*
  • Radiotherapy, Intensity-Modulated
  • Tomography, X-Ray Computed
  • Young Adult


  • Carbon Radioisotopes
  • Radiopharmaceuticals
  • Methionine