Dose-painted volumetric modulated arc therapy of high-grade glioma using 3,4-dihydroxy-6-[F]fluoro-l-phenylalanine positron emission tomography.

Objective: To determine whether dose painting with volumetric modulated arc therapy for high-grade gliomas using 3,4-dthydroxy-6-[F-18]fluoro-L-phenylalanine (F-18-FDOPA) positron emission tomography (PET) could achieve dose-escalated coverage of biological target volumes (BTVs) without increasing the dose to cranial organs at risk (OARs). Methods:10 patients with high-grade gliomas underwent CT, MRI, and F-18-FDOPA PET/CT images for post-operative radiation therapy planning. Two volumetric modulated arc therapy plans were retrospectively generated for each patient: a conventional plan with 60 Gy in 30 fractions to the planning target volume delineated on MRI and a dose-escalated plan with a maximum dose of 80 Gy in 30 fractions to BTVs. BTVs were created by thresholding F-18-FDOPA PET/CT uptake using a linear quadratic model that assumed tracer uptake was linearly related to tumour cell density. The maximum doses and equivalent uniform doses of OARs were compared. Results: The median volume of the planning target volume receiving at least 95% of the prescribed dose (V-95%) was 99.6% with and 99.5% without dose painting. The median V-95%, was >99.2% for BTVs. The maximum doses and equivalent uniform doses to the OARs did not differ significantly between the conventional and dose-painted plans. Conclusion: Using commercially available treatment planning software, dose painting for high-grade gliomas was feasible with good BTV coverage and no significant change in the dose to OARs. Advances in knowledge: A novel treatment planning strategy was used to achieve dose painting for gliomas with BTVs obtained from F-18-FDOPA PET/CT using a radiobiological model.