Intensity Modulated Radiation Therapy Versus Volumetric Arc Radiation Therapy in the Treatment of Glioblastoma—Does Clinical Benefit Follow Dosimetric Advantage?

PURPOSE: Volumetric modulated arc therapy (VMAT) has been shown by multiple planning studies to hold dosimetric advantages over intensity modulated radiation therapy (IMRT) in the management of brain tumors, including glioblastoma (GBM). Although promising, the clinical impact of these findings has...

Descripción completa

Detalles Bibliográficos
Autores principales: Sheu, Tommy, Briere, Tina M., Olanrewaju, Adenike M., McAleer, Mary Frances
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349632/
https://www.ncbi.nlm.nih.gov/pubmed/30706010
http://dx.doi.org/10.1016/j.adro.2018.09.010
_version_ 1783390290620448768
author Sheu, Tommy
Briere, Tina M.
Olanrewaju, Adenike M.
McAleer, Mary Frances
author_facet Sheu, Tommy
Briere, Tina M.
Olanrewaju, Adenike M.
McAleer, Mary Frances
author_sort Sheu, Tommy
collection PubMed
description PURPOSE: Volumetric modulated arc therapy (VMAT) has been shown by multiple planning studies to hold dosimetric advantages over intensity modulated radiation therapy (IMRT) in the management of brain tumors, including glioblastoma (GBM). Although promising, the clinical impact of these findings has not been fully elucidated. METHODS AND MATERIALS: We retrospectively reviewed consecutive patients with a pathologic-confirmed diagnosis of GBM who were treated between 2014 and 2015, a period that encompassed the transition from IMRT to VMAT at a single institution. After surgery, radiation with VMAT consisted of 2 to 3 coplanar arcs with or without an additional noncoplanar arc or IMRT with 5 to 6 gantry angles with concurrent and adjuvant temozolomide. Actuarial analyses were performed using the Kaplan Meier method. RESULTS: A total of 88 patients treated with IMRT (n = 45) and VMAT (n = 43) were identified. Patients were similar in terms of age, sex, performance status, extent of resection, and the high dose target volume. At a median follow-up time of 27 months (range, .7-32.3 months), the overall survival, freedom from progression, and freedom from new or worsening toxicity rates were not different between the 2 treatment groups (log-rank: P = .33; .87; and .23, respectively). There was no difference in incidences of alopecia, erythema, nausea, worsening or new onset fatigue, or headache during radiation, or temozolomide dose reduction for thrombocytopenia or neutropenia (all P > .05). Patterns of failure were different with more out of field failures in the IMRT group (P = .02). The mean time of treatment (TOT) was significantly reduced by 29% (P < .01) with VMAT (mean TOT: 10.3 minutes) compared with IMRT (mean TOT: 14.6 minutes). CONCLUSIONS: For GBM, treatment with VMAT results in similar oncologic and toxicity outcomes compared with IMRT and may improve resource utilization by reducing TOT. VMAT should be considered a potential radiation modality for patients with GBM.
format Online
Article
Text
id pubmed-6349632
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-63496322019-01-31 Intensity Modulated Radiation Therapy Versus Volumetric Arc Radiation Therapy in the Treatment of Glioblastoma—Does Clinical Benefit Follow Dosimetric Advantage? Sheu, Tommy Briere, Tina M. Olanrewaju, Adenike M. McAleer, Mary Frances Adv Radiat Oncol Central Nervous System PURPOSE: Volumetric modulated arc therapy (VMAT) has been shown by multiple planning studies to hold dosimetric advantages over intensity modulated radiation therapy (IMRT) in the management of brain tumors, including glioblastoma (GBM). Although promising, the clinical impact of these findings has not been fully elucidated. METHODS AND MATERIALS: We retrospectively reviewed consecutive patients with a pathologic-confirmed diagnosis of GBM who were treated between 2014 and 2015, a period that encompassed the transition from IMRT to VMAT at a single institution. After surgery, radiation with VMAT consisted of 2 to 3 coplanar arcs with or without an additional noncoplanar arc or IMRT with 5 to 6 gantry angles with concurrent and adjuvant temozolomide. Actuarial analyses were performed using the Kaplan Meier method. RESULTS: A total of 88 patients treated with IMRT (n = 45) and VMAT (n = 43) were identified. Patients were similar in terms of age, sex, performance status, extent of resection, and the high dose target volume. At a median follow-up time of 27 months (range, .7-32.3 months), the overall survival, freedom from progression, and freedom from new or worsening toxicity rates were not different between the 2 treatment groups (log-rank: P = .33; .87; and .23, respectively). There was no difference in incidences of alopecia, erythema, nausea, worsening or new onset fatigue, or headache during radiation, or temozolomide dose reduction for thrombocytopenia or neutropenia (all P > .05). Patterns of failure were different with more out of field failures in the IMRT group (P = .02). The mean time of treatment (TOT) was significantly reduced by 29% (P < .01) with VMAT (mean TOT: 10.3 minutes) compared with IMRT (mean TOT: 14.6 minutes). CONCLUSIONS: For GBM, treatment with VMAT results in similar oncologic and toxicity outcomes compared with IMRT and may improve resource utilization by reducing TOT. VMAT should be considered a potential radiation modality for patients with GBM. Elsevier 2018-09-28 /pmc/articles/PMC6349632/ /pubmed/30706010 http://dx.doi.org/10.1016/j.adro.2018.09.010 Text en © 2018 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Central Nervous System
Sheu, Tommy
Briere, Tina M.
Olanrewaju, Adenike M.
McAleer, Mary Frances
Intensity Modulated Radiation Therapy Versus Volumetric Arc Radiation Therapy in the Treatment of Glioblastoma—Does Clinical Benefit Follow Dosimetric Advantage?
title Intensity Modulated Radiation Therapy Versus Volumetric Arc Radiation Therapy in the Treatment of Glioblastoma—Does Clinical Benefit Follow Dosimetric Advantage?
title_full Intensity Modulated Radiation Therapy Versus Volumetric Arc Radiation Therapy in the Treatment of Glioblastoma—Does Clinical Benefit Follow Dosimetric Advantage?
title_fullStr Intensity Modulated Radiation Therapy Versus Volumetric Arc Radiation Therapy in the Treatment of Glioblastoma—Does Clinical Benefit Follow Dosimetric Advantage?
title_full_unstemmed Intensity Modulated Radiation Therapy Versus Volumetric Arc Radiation Therapy in the Treatment of Glioblastoma—Does Clinical Benefit Follow Dosimetric Advantage?
title_short Intensity Modulated Radiation Therapy Versus Volumetric Arc Radiation Therapy in the Treatment of Glioblastoma—Does Clinical Benefit Follow Dosimetric Advantage?
title_sort intensity modulated radiation therapy versus volumetric arc radiation therapy in the treatment of glioblastoma—does clinical benefit follow dosimetric advantage?
topic Central Nervous System
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349632/
https://www.ncbi.nlm.nih.gov/pubmed/30706010
http://dx.doi.org/10.1016/j.adro.2018.09.010
work_keys_str_mv AT sheutommy intensitymodulatedradiationtherapyversusvolumetricarcradiationtherapyinthetreatmentofglioblastomadoesclinicalbenefitfollowdosimetricadvantage
AT brieretinam intensitymodulatedradiationtherapyversusvolumetricarcradiationtherapyinthetreatmentofglioblastomadoesclinicalbenefitfollowdosimetricadvantage
AT olanrewajuadenikem intensitymodulatedradiationtherapyversusvolumetricarcradiationtherapyinthetreatmentofglioblastomadoesclinicalbenefitfollowdosimetricadvantage
AT mcaleermaryfrances intensitymodulatedradiationtherapyversusvolumetricarcradiationtherapyinthetreatmentofglioblastomadoesclinicalbenefitfollowdosimetricadvantage