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Nieder C.,Nordlandssykehuset HF Hospital | Nieder C.,University of Tromsø | Pawinski A.,Nordlandssykehuset HF Hospital | Haukland E.,Nordlandssykehuset HF Hospital | And 3 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2010

Purpose: Older surveys and benchmark data from different sources have suggested that 46-53% of all radiotherapy courses were administered with palliative intent. In Sweden, 87 annual palliative treatment courses per 100,000 inhabitants were registered in 2001, mainly for the treatment of bone and brain metastases (95% confidence interval [CI] 85-89). The corresponding number for Norway was 95 (95% CI 93-98) in 2004. New data are lacking, although new systemic treatment options might alter this number. Methods and Materials: We collected prospective data on the use of palliative external beam radiotherapy for adult cancer patients during a 12-month period between 2007 and 2008. All patients (median age 69 years) were treated in one Norwegian county and had unlimited, rapid access to treatment. Efforts were made to account for potential overuse. Results: Most irradiated patients had skeletal target volumes, followed by nonbony thoracic targets and brain metastases. In the present population, 133 annual treatments per 100,000 inhabitants were registered (after correction for overuse, but not accounting for radiosurgery of brain metastases and emerging treatment options; e.g., stereotactic radiotherapy for lung and liver metastases; 95% CI 119-149). Because some patients received simultaneous treatment to different target volumes, the annual number of target volumes amounted to 175 per 100,000 inhabitants (95% CI 161-191). Conclusion: The need for palliative radiotherapy has not decreased and might be greater than previously estimated. In regions with a significantly different cancer incidence, age structure, and other socioeconomic factors than northern Europe, separate analyses should be conducted. © 2010 Elsevier Inc. All rights reserved.


Grosu A.-L.,Albert Ludwigs University of Freiburg | Grosu A.-L.,TU Munich | Astner S.T.,TU Munich | Riedel E.,TU Munich | And 11 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: L-[methyl- 11C]methionine (MET)-positron emission tomography (PET) has a high sensitivity and specificity for imaging of gliomas and metastatic brain tumors. The short half-life of 11C (20 minutes) limits the use of MET-PET to institutions with onsite cyclotron. O-(2- [ 18F]fluoroethyl)-L-tyrosine (FET) is labeled with 18F (half-life, 120 minutes) and could be used much more broadly. This study compares the uptake of FET and MET in gliomas and metastases, as well as treatment-induced changes. Furthermore, it evaluates the gross tumor volume (GTV) of gliomas defined on PET and magnetic resonance imaging (MRI). Methods and Materials: We examined 42 patients with pretreated gliomas (29 patients) or brain metastases (13 patients) prospectively by FET- and MET-PET on the same day. Uptake of FET and MET was quantified by standardized uptake values. Imaging contrast was assessed by calculating lesion-to-gray matter ratios. Tumor extension was quantified by contouring GTV in 17 patients with brain gliomas. Gross tumor volume on PET was compared with GTV on MRI. Sensitivity and specificity of MET- and FET-PET for differentiation of viable tumor from benign changes were evaluated by comparing the PET result with histology or clinical follow-up. Results: There was a strong linear correlation between standardized uptake values calculated for both tracers in cortex and lesions: r = 0.78 (p = 0.001) and r = 0.84 (p < 0.001), respectively. Image contrast was similar for MET- and FET-PET (lesion-to-gray matter ratios of 2.36 ± 1.01 and 2.33 ± 0.77, respectively). Mean GTV in 17 glioma patients was not significantly different on MET- and FET-PET. Both MET- and FET-PET delineated tumor tissue outside of MRI changes. Both tracers provided differentiated tumor tissue and treatment-related changes with a sensitivity of 91% at a specificity of 100%. Conclusions: O-(2- [ 18F]fluoroethyl)-L-tyrosine-PET and MET-PET provide comparable diagnostic information on gliomas and brain metastases. Like MET-PET, FET-PET can be used for differentiation of residual or recurrent tumor from treatment-related changes/pseudoprogression, as well as for delineation of gliomas. © 2011 Elsevier Inc.

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