Optune

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evilbooyaa said:
Isn't it metal though? You simmed without device but treated with device? Were there concerns about potential dosiemtry changes? Can't tell off of colors if that is an IMRT plan or not.
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Optune is metal but that sits by patients waist. On the scalp there are just electrodes. Vmat plan to 60. I didnt recommend it but guy has huge butterfly molecularly really unfavorable gbm crossing cc and not going to stop him. It is very possible that was small attenuation of beam.
 
nkmiami said:
Optune is metal but that sits by patients waist. On the scalp there are just electrodes. Vmat plan to 60. I didnt recommend it but guy has huge butterfly molecularly really unfavorable gbm crossing cc and not going to stop him. It is very possible that was small attenuation of beam.
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OK fair enough. I'll be honest that since we don't actively manage it here I've never actually seen one attached. Thought it had more metal along the helmet portion.
 
evilbooyaa said:
OK fair enough. I'll be honest that since we don't actively manage it here I've never actually seen one attached. Thought it had more metal along the helmet portion.
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He was well informed 75 year old doc seen at duke.
 
evilbooyaa said:
OK fair enough. I'll be honest that since we don't actively manage it here I've never actually seen one attached. Thought it had more metal along the helmet portion.
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Haven’t examined it closely but they look just like ekg electrodes that are sticky
 
evilbooyaa said:
OK fair enough. I'll be honest that since we don't actively manage it here I've never actually seen one attached. Thought it had more metal along the helmet portion.
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No helmet per se. Like nkmiami said, just interspersed EKG-ish electrodes about the head. (There is some "dosimetry" to this, they have planning software.) A "cap" or covering is then placed on to keep it tidy, less weird looking, etc. Can obviously let patient wear their own cap or what not. The attenuation of the beam would be very very minimal; even with metal, we're still Compton-ing not photoelectric-ing (ie attenuation/interaction not proportional to atomic number) and it's nothing like the size of dental work or hip replacements which can attenuate MV beams. Since it's ~1-3mm or less of material I wouldn't even worry of a bolus effect.
 
PhotonBomb said:
I’ve never gotten a PET for GBM patient. Interesting
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There are so many new radiotracers, I can't keep up.

In the CNS, I'm aware of Dotatate PET scan for meningioma and FLT PETs for gliomas.

In the prostate, it's like there's a new and better one every day. I just learned about PyL scans today and how they are supposed to blow Axumin away.
 
You can do FET-PET for GBMs.
There are some groups using that for contouring and they have shown that contours when using both FET and MRI can be quite different than only with MRI. However, it remains unclear if contouring based on both alters the clinical course.
 
I routinely spare uninvolved hippocampus/hippocampii in gliomas (including glioblastoma) and consider use of memantine if patient is complaining of neurocog issues. Whether it makes sense to give memantine prophylactically for glioma might as well be another clinical trial.

There was a group using whole brain MR Spectroscopy to dose paint to glioblastoma. If they're to be believed, it seems like a high density of tumors cells extend far from some tumors and aren't seen by T1+contrast and/or T2 changes.
 
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