Impact of CTV margin reduction in glioblastoma patients treated with concurrent chemoradiation

IF 2.4 Q2 CLINICAL NEUROLOGY Neuro-oncology practice Pub Date : 2023-10-27 DOI:10.1093/nop/npad071
Dario Di Perri, David Hofstede, Dianne Hartgerink, Karin Terhaag, Ruud Houben, Alida A Postma, Ann Hoeben, Monique Anten, Linda Ackermans, Inge Compter, Daniëlle B P Eekers
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Abstract

Abstract Background Glioblastoma (GBM) is widely treated using large radiotherapy margins, resulting in substantial irradiation of the surrounding cerebral structures. In this context, the question arises whether these margins could be safely reduced. In 2018, clinical target volume (CTV) expansion was reduced in our institution from 20 to 15 mm around the gross target volume (GTV) (ie, the contrast-enhancing tumor/cavity). We sought to retrospectively analyze the impact of this reduction. Methods All adult patients with GBM treated between January 2015 and December 2020 with concurrent chemoradiation (60Gy/2Gy or 59.4Gy/1.8Gy) were analyzed. Patients treated using a 20 (CTV20, n = 57) or 15 mm (CTV15, n = 56) CTV margin were compared for target volumes, dose parameters to the surrounding organs, pattern of recurrence, and survival outcome. Results Mean GTV was similar in both groups (ie, CTV20: 39.7cm3; CTV15: 37.8cm3; P = .71). Mean CTV and PTV were reduced from 238.9cm3 to 176.7cm3 (P = .001) and from 292.6cm3 to 217.0cm3 (P < .001), for CTV20 and CTV15, respectively. As a result, average brain mean dose (Dmean) was reduced from 25.2Gy to 21.0Gy (P = .002). Significantly lower values were also observed for left hippocampus Dmean, brainstem D0.03cc, cochleas Dmean, and pituitary Dmean. Pattern of recurrence was similar, as well as patient outcome, ie, median progression-free survival was 8.0 and 7.0 months (P = .80), and median overall survival was 11.0 and 14.0 months (P = .61) for CTV20 and CTV15, respectively. Conclusions In GBM patients treated with chemoradiation, reducing the CTV margin from 20 to 15 mm appears to be safe and offers the potential for less treatment toxicity.
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同步放化疗对胶质母细胞瘤患者CTV切缘减少的影响
摘要背景胶质母细胞瘤(GBM)广泛使用大放射治疗边缘,导致周围大脑结构的大量照射。在这方面,问题是这些差额是否可以安全地减少。2018年,我院临床靶体积(CTV)的扩张范围从总靶体积(GTV)(即增强肿瘤/腔)周围的20毫米缩小到15毫米。我们试图回顾性分析这种减少的影响。方法分析2015年1月至2020年12月期间接受同步放化疗(60Gy/2Gy或59.4Gy/1.8Gy)治疗的所有成年GBM患者。采用20 (CTV20, n = 57)或15 mm (CTV15, n = 56) CTV切缘治疗的患者比较靶体积、对周围器官的剂量参数、复发模式和生存结果。结果两组平均GTV相似(CTV20: 39.7cm3;CTV15: 37.8立方厘米;P = .71)。平均CTV和PTV从238.9cm3降至176.7cm3 (P = 0.001),从292.6cm3降至217.0cm3 (P <.001),分别为CTV20和CTV15。结果脑平均剂量(Dmean)由25.2Gy降至21.0Gy (P = 0.002)。左海马Dmean、脑干D0.03cc、耳蜗Dmean、垂体Dmean均显著降低。复发模式和患者结局相似,即CTV20和CTV15的中位无进展生存期分别为8.0和7.0个月(P = 0.80),中位总生存期分别为11.0和14.0个月(P = 0.61)。结论在接受放化疗的GBM患者中,将CTV边缘从20 mm减少到15 mm似乎是安全的,并且有可能减少治疗毒性。
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来源期刊
Neuro-oncology practice
Neuro-oncology practice CLINICAL NEUROLOGY-
CiteScore
5.30
自引率
11.10%
发文量
92
期刊介绍: Neuro-Oncology Practice focuses on the clinical aspects of the subspecialty for practicing clinicians and healthcare specialists from a variety of disciplines including physicians, nurses, physical/occupational therapists, neuropsychologists, and palliative care specialists, who have focused their careers on clinical patient care and who want to apply the latest treatment advances to their practice. These include: Applying new trial results to improve standards of patient care Translating scientific advances such as tumor molecular profiling and advanced imaging into clinical treatment decision making and personalized brain tumor therapies Raising awareness of basic, translational and clinical research in areas of symptom management, survivorship, neurocognitive function, end of life issues and caregiving
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