RADT-31. 68GA-DOTATATE PET VERSUS MRI-BASED TREATMENT PLANNING FOR POST-OPERATIVE AND INTACT MENINGIOMA: A DOSIMETRIC ANALYSIS. (14th November 2022) - Perlow, Haley
Abstract: Background: Nearly all meningiomas express somatostatin receptor 1/2 (SSTR1/SSTR2); therefore, SSTR ligands such as 68 Ga-DOTATATE can be utilized for meningioma radiotherapy treatment planning. Incorporation of 68 Ga-DOTATATE PET assists with target delineation and may reduce the dose to organs-at-risk (OARs). We hypothesize that 68 Ga-DOTATATE PET-based treatment plans will reduce dose to OARs when compared to MRI-based plans. METHODS: All treatment plans were rendered on computed tomography (CT) planning datasets, using RapidArc and 6MV photon energy. Two arcs were positioned on the coplanar axis with alternated collimator settings of 0 and 90 degrees to promote MLC sparing with a third unique vertex arc chosen independently to spare normal brain tissue and associated organs at risk (OAR). For MRI structures, a 1 cm expansion from the gross tumor volume (GTV) created a clinical treatment volume (CTV)60. A 2 cm expansion created a CTV54. For PET structures, a 1 cm expansion from the GTV created a CTV60. A 3 mm isotropic expansion created planning treatment volumes (PTVs). Plans were optimized such that Dmax to brainstem remained limited to 60Gy or less and Dmax to optic structures was limited to 54Gy or less. RESULTS: 18 meningioma patients were included (9 post-operative, 9 intact). The mean PTV volume using MRI was 258 ccs (306 ccs for post-operative, 210 ccs for intact), and the mean PTV volume using PET was 60 ccs (97 ccs for post-operative, 91 ccs for intact). The mean radiation dose to both optic nerves, the optic chiasm, both hippocampi, and the brainstem was reduced favoring PET-based treatment plans for both post-operative and intact patients. CONCLUSION: Our study shows that incorporation of 68 Ga-DOTATATE PET can reduce dose to OARs for post-operative and intact patients, and this difference may translate to reduced toxicity. 68 Ga-DOTATATE PET guided radiation treatments are worthy of future prospective investigation.