Consensus Radiation Treatment Planning Guidelines Utilizing (68)Ga-DOTATATE PET/CT for Resected Meningiomas

Haley K Perlow; David R Raleigh; Tony J C Wang; Erqi L Pollom; Michael T Milano; William G Breen; Jay Detsky; Eric L Chang; Martin C Tom; Kevin R Shiue; Eric J Lehrer; Hina Saeed; Luke R G Pike; Simon S Lo; Mark V Mishra; Jonathan P S Knisely; Samuel T Chao; Arjun Sahgal; Joshua D Palmer

doi:10.1016/j.ijrobp.2024.12.003

Consensus Radiation Treatment Planning Guidelines Utilizing (68)Ga-DOTATATE PET/CT for Resected Meningiomas

Int J Radiat Oncol Biol Phys. 2024 Dec 17:S0360-3016(24)03726-X. doi: 10.1016/j.ijrobp.2024.12.003. Online ahead of print.

Authors

Haley K Perlow¹, David R Raleigh², Tony J C Wang³, Erqi L Pollom⁴, Michael T Milano⁵, William G Breen⁶, Jay Detsky⁷, Eric L Chang⁸, Martin C Tom⁹, Kevin R Shiue¹⁰, Eric J Lehrer⁶, Hina Saeed¹¹, Luke R G Pike¹², Simon S Lo¹³, Mark V Mishra¹⁴, Jonathan P S Knisely¹⁵, Samuel T Chao¹⁶, Arjun Sahgal⁷, Joshua D Palmer¹⁷

Affiliations

¹ Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
² Departments of Radiation Oncology, Neurological Surgery, and Pathology, University of California, San Francisco, California.
³ Department of Radiation Oncology, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York.
⁴ Department of Radiation Oncology, Stanford University, Stanford, CA.
⁵ Department of Radiation Oncology, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, New York.
⁶ Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, Minnesota.
⁷ Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
⁸ Department of Radiation Oncology, Keck School of Medicine and Norris Cancer Center at University of Southern California, CA.
⁹ Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas.
¹⁰ Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
¹¹ Lynn Cancer Institute, Department of Radiation Oncology, Baptist Health South Florida, Boca Raton, Florida.
¹² Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
¹³ Department of Radiation Oncology, University of Washington and Fred Hutch Cancer Center, Seattle, Washington.
¹⁴ Department of Radiation Oncology, University of Maryland, Baltimore, Maryland.
¹⁵ Department of Radiation Oncology, Weill Cornell Medicine, New York, New York.
¹⁶ Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio.
¹⁷ Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address: [email protected].

PMID: 39701546
DOI: 10.1016/j.ijrobp.2024.12.003

Abstract

Background: Meningiomas are the most common primary intracranial tumor. Somatostatin receptor 2 (SSTR 2) is almost universally expressed in meningioma tissue. For patients who require adjuvant radiation, SSTR based (68)Ga-DOTATATE positron emission tomography (PET) imaging can detect additional or residual disease not discernible on magnetic resonance imaging (MRI). PET-guided radiation treatments may improve local control, minimize toxicity by allowing for more precise radiotherapy plans, and allow for more precise dose escalation to maximize local control. The aim of this study was to develop consensus PET-guided treatment planning guidelines for common meningioma presentations.

Methods: Five post-operative clinically relevant meningioma cases were selected from a prospective single-institutional registry of patients. Each patient had a preoperative and post-operative contrast enhanced T1-weighted volumetric MRI, and a post-operative (68)Ga-DOTATATE PET/CT, to assist with target delineation. The full treatment scenario including clinical history, histology, surgical history, and imaging were provided for each patient. Nineteen international experts who have published on the treatment and management of meningiomas, and who utilize (68)Ga-DOTATATE PET/CT in their practice, evaluated each case. Individual prescription recommendations were created, pooled, and discussed to create consensus recommendations.

Results: Consensus recommendations were created for each case. In most cases, PET-based contouring allowed for more precise-dose escalation to 66-70Gy targeting residual disease. When compared to RTOG 0539 and modern clinical trial contouring guidelines, a smaller CTV expansion from the surgical cavity was recommended using PET-guided radiation plans in the absence of radiographic or pathologic evidence of brain or bone invasion.

Conclusion: This report provides consensus target volume delineation guidelines for meningiomas receiving postoperative radiation in common clinical situations. Integration of these guidelines into clinical practice may allow for more precise biomarker-guided radiation treatments and standardize radiotherapy on future meningioma clinical trials.