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. Author manuscript; available in PMC: 2015 Dec 1.
Published in final edited form as: Int J Radiat Oncol Biol Phys. 2014 Dec 1;90(5):1030–1036. doi: 10.1016/j.ijrobp.2014.08.016

Figure 1.

Figure 1

[18F] fluoromisonidazole positron emission tomography/computed tomography (FMISO-PET/CT) visualization of hypoxic chordoma sub-volumes (HSV) and theoretical use for dose-escalated intensity modulated proton therapy (IMPT). (A) Pre-treatment T2-weighted MRI demonstrating a 22.8 cm sacral chordoma. (B) Pre-treatment FMISO-PET/CT fused with radiation planning CT showing contoured HSV, gross tumor volume (GTV), clinical target volume (CTV), bladder, and rectum. (C) FMISO-PET/CT fused with radiation planning CT after 25.2 GyRBE (relative biologic effectiveness) with additionally contoured interval HSV and 3 mm expansion of combined HSVs. (D) Actual delivered proton/photon treatment plan to 73.8 GyRBE to the GTV. (E) Theoretical IMPT plan to 77.4 GyRBE to the GTV with integrated boost to the combined pre-treatment and interval HSVs to 84.9 GyRBE.