Co-registration of MR and FDG-PET imaging for stereotactic radiotherapy planning; case report in a previously irradiated brain metastasis with recurrent tumor and radiation necrosis

Robert A Scranton; Saeed Sadrameli; E Brian Butler; Andrew Farach; Hui-Chuan Wang; Bin S Teh; Ivo W Tremont-Lukats; Steve H Fung; Paolo Zanotti-Fregonara; Robert C Rostomily

doi:10.1016/j.prro.2019.11.008

Co-registration of MR and FDG-PET imaging for stereotactic radiotherapy planning; case report in a previously irradiated brain metastasis with recurrent tumor and radiation necrosis

Robert A Scranton, Saeed Sadrameli, E Brian Butler, Andrew Farach, Hui-Chuan Wang, Bin S Teh, Ivo W Tremont-Lukats, Steve H Fung, Paolo Zanotti-Fregonara, Robert C Rostomily

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4 Scopus citations

Abstract

Stereotactic radiosurgery (SRS) or radiotherapy (SRT) is commonly used to treat brain metastasis (BM). While effective in achieving tumor control, a significant number of BM patients exhibit lesion growth on follow-up MR imaging after SRS which cannot reliably distinguish between tumor growth, radiation necrosis (RN) or a mixture of both. SRS retreatment is a therapeutic option for tumor regrowth but contraindicated for RN. Here, we describe an instructive case of MRI progression of a breast BM previously treated by SRS where [18F] fludeoxyglucose-positron emission tomography (FDG-PET) proved useful to anatomically delineate metabolically active tumor from RN for re-treatment planning. Post-treatment FDG-PET and MRI studies indicated decreased uptake and enhancement respectively following treatment. This case study underscores the biological heterogeneity underlying MRI based BM progression after prior SRS and the potential utility of FDG-PET to guide treatment planning for repeat SRS.

Original language	English (US)
Journal	Practical Radiation Oncology
DOIs	https://doi.org/10.1016/j.prro.2019.11.008
State	E-pub ahead of print - Nov 29 2019

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Scranton, R. A., Sadrameli, S., Butler, E. B., Farach, A., Wang, H.-C., Teh, B. S., Tremont-Lukats, I. W., Fung, S. H., Zanotti-Fregonara, P., & Rostomily, R. C. (2019). Co-registration of MR and FDG-PET imaging for stereotactic radiotherapy planning; case report in a previously irradiated brain metastasis with recurrent tumor and radiation necrosis. Practical Radiation Oncology. Advance online publication. https://doi.org/10.1016/j.prro.2019.11.008

Scranton, RA, Sadrameli, S, Butler, EB , Farach, A, Wang, H-C, Teh, BS, Tremont-Lukats, IW, Fung, SH, Zanotti-Fregonara, P & Rostomily, RC 2019, 'Co-registration of MR and FDG-PET imaging for stereotactic radiotherapy planning; case report in a previously irradiated brain metastasis with recurrent tumor and radiation necrosis', Practical Radiation Oncology. https://doi.org/10.1016/j.prro.2019.11.008

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title = "Co-registration of MR and FDG-PET imaging for stereotactic radiotherapy planning; case report in a previously irradiated brain metastasis with recurrent tumor and radiation necrosis",

abstract = "Stereotactic radiosurgery (SRS) or radiotherapy (SRT) is commonly used to treat brain metastasis (BM). While effective in achieving tumor control, a significant number of BM patients exhibit lesion growth on follow-up MR imaging after SRS which cannot reliably distinguish between tumor growth, radiation necrosis (RN) or a mixture of both. SRS retreatment is a therapeutic option for tumor regrowth but contraindicated for RN. Here, we describe an instructive case of MRI progression of a breast BM previously treated by SRS where [18F] fludeoxyglucose-positron emission tomography (FDG-PET) proved useful to anatomically delineate metabolically active tumor from RN for re-treatment planning. Post-treatment FDG-PET and MRI studies indicated decreased uptake and enhancement respectively following treatment. This case study underscores the biological heterogeneity underlying MRI based BM progression after prior SRS and the potential utility of FDG-PET to guide treatment planning for repeat SRS.",

author = "Scranton, {Robert A} and Saeed Sadrameli and Butler, {E Brian} and Andrew Farach and Hui-Chuan Wang and Teh, {Bin S} and Tremont-Lukats, {Ivo W} and Fung, {Steve H} and Paolo Zanotti-Fregonara and Rostomily, {Robert C}",

note = "Copyright {\textcopyright} 2019. Published by Elsevier Inc.",

year = "2019",

month = nov,

day = "29",

doi = "10.1016/j.prro.2019.11.008",

language = "English (US)",

journal = "Practical Radiation Oncology",

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AU - Scranton, Robert A

AU - Sadrameli, Saeed

AU - Butler, E Brian

AU - Farach, Andrew

AU - Wang, Hui-Chuan

AU - Teh, Bin S

AU - Tremont-Lukats, Ivo W

AU - Fung, Steve H

AU - Zanotti-Fregonara, Paolo

AU - Rostomily, Robert C

PY - 2019/11/29

Y1 - 2019/11/29

N2 - Stereotactic radiosurgery (SRS) or radiotherapy (SRT) is commonly used to treat brain metastasis (BM). While effective in achieving tumor control, a significant number of BM patients exhibit lesion growth on follow-up MR imaging after SRS which cannot reliably distinguish between tumor growth, radiation necrosis (RN) or a mixture of both. SRS retreatment is a therapeutic option for tumor regrowth but contraindicated for RN. Here, we describe an instructive case of MRI progression of a breast BM previously treated by SRS where [18F] fludeoxyglucose-positron emission tomography (FDG-PET) proved useful to anatomically delineate metabolically active tumor from RN for re-treatment planning. Post-treatment FDG-PET and MRI studies indicated decreased uptake and enhancement respectively following treatment. This case study underscores the biological heterogeneity underlying MRI based BM progression after prior SRS and the potential utility of FDG-PET to guide treatment planning for repeat SRS.

AB - Stereotactic radiosurgery (SRS) or radiotherapy (SRT) is commonly used to treat brain metastasis (BM). While effective in achieving tumor control, a significant number of BM patients exhibit lesion growth on follow-up MR imaging after SRS which cannot reliably distinguish between tumor growth, radiation necrosis (RN) or a mixture of both. SRS retreatment is a therapeutic option for tumor regrowth but contraindicated for RN. Here, we describe an instructive case of MRI progression of a breast BM previously treated by SRS where [18F] fludeoxyglucose-positron emission tomography (FDG-PET) proved useful to anatomically delineate metabolically active tumor from RN for re-treatment planning. Post-treatment FDG-PET and MRI studies indicated decreased uptake and enhancement respectively following treatment. This case study underscores the biological heterogeneity underlying MRI based BM progression after prior SRS and the potential utility of FDG-PET to guide treatment planning for repeat SRS.

U2 - 10.1016/j.prro.2019.11.008

DO - 10.1016/j.prro.2019.11.008

M3 - Article

C2 - 31790826

SN - 1879-8500

JO - Practical Radiation Oncology

JF - Practical Radiation Oncology

ER -

Co-registration of MR and FDG-PET imaging for stereotactic radiotherapy planning; case report in a previously irradiated brain metastasis with recurrent tumor and radiation necrosis

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