Cargando…

Location of Recurrences after Trimodality Treatment for Glioblastoma with Respect to the Delivered Radiation Dose Distribution and Its Influence on Prognosis

SIMPLE SUMMARY: This scientific research characterizes the recurrence pattern of patients with glioblastoma after trimodality treatment, neurosurgery and radiation therapy, either intensity modulated radiation therapy (IMRT) or volumetric intensity modulated arc therapy (VMAT), as well as concurrent...

Descripción completa

Detalles Bibliográficos
Autores principales: Guberina, Nika, Padeberg, Florian, Pöttgen, Christoph, Guberina, Maja, Lazaridis, Lazaros, Jabbarli, Ramazan, Deuschl, Cornelius, Herrmann, Ken, Blau, Tobias, Wrede, Karsten H., Keyvani, Kathy, Scheffler, Björn, Hense, Jörg, Layer, Julian P., Glas, Martin, Sure, Ulrich, Stuschke, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10252044/
https://www.ncbi.nlm.nih.gov/pubmed/37296942
http://dx.doi.org/10.3390/cancers15112982
_version_ 1785056076878577664
author Guberina, Nika
Padeberg, Florian
Pöttgen, Christoph
Guberina, Maja
Lazaridis, Lazaros
Jabbarli, Ramazan
Deuschl, Cornelius
Herrmann, Ken
Blau, Tobias
Wrede, Karsten H.
Keyvani, Kathy
Scheffler, Björn
Hense, Jörg
Layer, Julian P.
Glas, Martin
Sure, Ulrich
Stuschke, Martin
author_facet Guberina, Nika
Padeberg, Florian
Pöttgen, Christoph
Guberina, Maja
Lazaridis, Lazaros
Jabbarli, Ramazan
Deuschl, Cornelius
Herrmann, Ken
Blau, Tobias
Wrede, Karsten H.
Keyvani, Kathy
Scheffler, Björn
Hense, Jörg
Layer, Julian P.
Glas, Martin
Sure, Ulrich
Stuschke, Martin
author_sort Guberina, Nika
collection PubMed
description SIMPLE SUMMARY: This scientific research characterizes the recurrence pattern of patients with glioblastoma after trimodality treatment, neurosurgery and radiation therapy, either intensity modulated radiation therapy (IMRT) or volumetric intensity modulated arc therapy (VMAT), as well as concurrent chemotherapy in a clinical setting based on daily image-guided radiation therapy (IGRT) at the West German Cancer Center. This study underlines the importance of reconsideration of clinical target volume margins in the clinical routine. Larger radiation therapy margins may decrease the proportion of out-field recurrences, but an effect on overall survival is highly questionable. ABSTRACT: Background: While prognosis of glioblastoma after trimodality treatment is well examined, recurrence pattern with respect to the delivered dose distribution is less well described. Therefore, here we examine the gain of additional margins around the resection cavity and gross-residual-tumor. Methods: All recurrent glioblastomas initially treated with radiochemotherapy after neurosurgery were included. The percentage overlap of the recurrence with the gross tumor volume (GTV) expanded by varying margins (10 mm to 20 mm) and with the 95% and 90% isodose was measured. Competing-risks analysis was performed in dependence on recurrence pattern. Results: Expanding the margins from 10 mm to 15 mm, to 20 mm, to the 95%- and 90% isodose of the delivered dose distribution with a median margin of 27 mm did moderately increase the proportion of relative in-field recurrence volume from 64% to 68%, 70%, 88% and 88% (p < 0.0001). Overall survival of patients with in-and out-field recurrence was similar (p = 0.7053). The only prognostic factor significantly associated with out-field recurrence was multifocality of recurrence (p = 0.0037). Cumulative incidences of in-field recurrences at 24 months were 60%, 22% and 11% for recurrences located within a 10 mm margin, outside a 10 mm margin but within the 95% isodose, or outside the 95% isodose (p < 0.0001). Survival from recurrence was improved after complete resection (p = 0.0069). Integrating these data into a concurrent-risk model shows that extending margins beyond 10 mm has only small effects on survival hardly detectable by clinical trials. Conclusions: Two-thirds of recurrences were observed within a 10 mm margin around the GTV. Smaller margins reduce normal brain radiation exposure allowing for more extensive salvage radiation therapy options in case of recurrence. Prospective trials using margins smaller than 20 mm around the GTV are warranted.
format Online
Article
Text
id pubmed-10252044
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-102520442023-06-10 Location of Recurrences after Trimodality Treatment for Glioblastoma with Respect to the Delivered Radiation Dose Distribution and Its Influence on Prognosis Guberina, Nika Padeberg, Florian Pöttgen, Christoph Guberina, Maja Lazaridis, Lazaros Jabbarli, Ramazan Deuschl, Cornelius Herrmann, Ken Blau, Tobias Wrede, Karsten H. Keyvani, Kathy Scheffler, Björn Hense, Jörg Layer, Julian P. Glas, Martin Sure, Ulrich Stuschke, Martin Cancers (Basel) Article SIMPLE SUMMARY: This scientific research characterizes the recurrence pattern of patients with glioblastoma after trimodality treatment, neurosurgery and radiation therapy, either intensity modulated radiation therapy (IMRT) or volumetric intensity modulated arc therapy (VMAT), as well as concurrent chemotherapy in a clinical setting based on daily image-guided radiation therapy (IGRT) at the West German Cancer Center. This study underlines the importance of reconsideration of clinical target volume margins in the clinical routine. Larger radiation therapy margins may decrease the proportion of out-field recurrences, but an effect on overall survival is highly questionable. ABSTRACT: Background: While prognosis of glioblastoma after trimodality treatment is well examined, recurrence pattern with respect to the delivered dose distribution is less well described. Therefore, here we examine the gain of additional margins around the resection cavity and gross-residual-tumor. Methods: All recurrent glioblastomas initially treated with radiochemotherapy after neurosurgery were included. The percentage overlap of the recurrence with the gross tumor volume (GTV) expanded by varying margins (10 mm to 20 mm) and with the 95% and 90% isodose was measured. Competing-risks analysis was performed in dependence on recurrence pattern. Results: Expanding the margins from 10 mm to 15 mm, to 20 mm, to the 95%- and 90% isodose of the delivered dose distribution with a median margin of 27 mm did moderately increase the proportion of relative in-field recurrence volume from 64% to 68%, 70%, 88% and 88% (p < 0.0001). Overall survival of patients with in-and out-field recurrence was similar (p = 0.7053). The only prognostic factor significantly associated with out-field recurrence was multifocality of recurrence (p = 0.0037). Cumulative incidences of in-field recurrences at 24 months were 60%, 22% and 11% for recurrences located within a 10 mm margin, outside a 10 mm margin but within the 95% isodose, or outside the 95% isodose (p < 0.0001). Survival from recurrence was improved after complete resection (p = 0.0069). Integrating these data into a concurrent-risk model shows that extending margins beyond 10 mm has only small effects on survival hardly detectable by clinical trials. Conclusions: Two-thirds of recurrences were observed within a 10 mm margin around the GTV. Smaller margins reduce normal brain radiation exposure allowing for more extensive salvage radiation therapy options in case of recurrence. Prospective trials using margins smaller than 20 mm around the GTV are warranted. MDPI 2023-05-30 /pmc/articles/PMC10252044/ /pubmed/37296942 http://dx.doi.org/10.3390/cancers15112982 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Guberina, Nika
Padeberg, Florian
Pöttgen, Christoph
Guberina, Maja
Lazaridis, Lazaros
Jabbarli, Ramazan
Deuschl, Cornelius
Herrmann, Ken
Blau, Tobias
Wrede, Karsten H.
Keyvani, Kathy
Scheffler, Björn
Hense, Jörg
Layer, Julian P.
Glas, Martin
Sure, Ulrich
Stuschke, Martin
Location of Recurrences after Trimodality Treatment for Glioblastoma with Respect to the Delivered Radiation Dose Distribution and Its Influence on Prognosis
title Location of Recurrences after Trimodality Treatment for Glioblastoma with Respect to the Delivered Radiation Dose Distribution and Its Influence on Prognosis
title_full Location of Recurrences after Trimodality Treatment for Glioblastoma with Respect to the Delivered Radiation Dose Distribution and Its Influence on Prognosis
title_fullStr Location of Recurrences after Trimodality Treatment for Glioblastoma with Respect to the Delivered Radiation Dose Distribution and Its Influence on Prognosis
title_full_unstemmed Location of Recurrences after Trimodality Treatment for Glioblastoma with Respect to the Delivered Radiation Dose Distribution and Its Influence on Prognosis
title_short Location of Recurrences after Trimodality Treatment for Glioblastoma with Respect to the Delivered Radiation Dose Distribution and Its Influence on Prognosis
title_sort location of recurrences after trimodality treatment for glioblastoma with respect to the delivered radiation dose distribution and its influence on prognosis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10252044/
https://www.ncbi.nlm.nih.gov/pubmed/37296942
http://dx.doi.org/10.3390/cancers15112982
work_keys_str_mv AT guberinanika locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT padebergflorian locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT pottgenchristoph locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT guberinamaja locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT lazaridislazaros locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT jabbarliramazan locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT deuschlcornelius locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT herrmannken locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT blautobias locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT wredekarstenh locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT keyvanikathy locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT schefflerbjorn locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT hensejorg locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT layerjulianp locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT glasmartin locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT sureulrich locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis
AT stuschkemartin locationofrecurrencesaftertrimodalitytreatmentforglioblastomawithrespecttothedeliveredradiationdosedistributionanditsinfluenceonprognosis