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Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma

PURPOSE: To simulate and analyze the dosimetric differences of intraoperative radiotherapy (IORT) or pre-operative single-fraction stereotactic radiosurgery (SRS) in addition to post-operative external beam radiotherapy (EBRT) in Glioblastoma (GB). METHODS: Imaging series of previously treated patie...

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Autores principales: Sarria, Gustavo R., Smalec, Zuzanna, Muedder, Thomas, Holz, Jasmin A., Scafa, Davide, Koch, David, Garbe, Stephan, Schneider, Matthias, Hamed, Motaz, Vatter, Hartmut, Herrlinger, Ulrich, Giordano, Frank A., Schmeel, Leonard Christopher
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8581360/
https://www.ncbi.nlm.nih.gov/pubmed/34778080
http://dx.doi.org/10.3389/fonc.2021.759873
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author Sarria, Gustavo R.
Smalec, Zuzanna
Muedder, Thomas
Holz, Jasmin A.
Scafa, Davide
Koch, David
Garbe, Stephan
Schneider, Matthias
Hamed, Motaz
Vatter, Hartmut
Herrlinger, Ulrich
Giordano, Frank A.
Schmeel, Leonard Christopher
author_facet Sarria, Gustavo R.
Smalec, Zuzanna
Muedder, Thomas
Holz, Jasmin A.
Scafa, Davide
Koch, David
Garbe, Stephan
Schneider, Matthias
Hamed, Motaz
Vatter, Hartmut
Herrlinger, Ulrich
Giordano, Frank A.
Schmeel, Leonard Christopher
author_sort Sarria, Gustavo R.
collection PubMed
description PURPOSE: To simulate and analyze the dosimetric differences of intraoperative radiotherapy (IORT) or pre-operative single-fraction stereotactic radiosurgery (SRS) in addition to post-operative external beam radiotherapy (EBRT) in Glioblastoma (GB). METHODS: Imaging series of previously treated patients with adjuvant radiochemotherapy were analyzed. For SRS target definition, pre-operative MRIs were co-registered to planning CT scans and a pre-operative T1-weighted gross target volume (GTV) plus a 2-mm planning target volume (PTV) were created. For IORT, a modified (m)GTV was expanded from the pre-operative volume, in order to mimic a round cavity as during IORT. Dose prescription was 20 Gy, homogeneously planned for SRS and calculated at the surface for IORT, to cover 99% and 90% of the volumes, respectively. For tumors > 2cm in maximum diameter, a 15 Gy dose was prescribed. Plan assessment was performed after calculating the 2-Gy equivalent doses (EQD2) for both boost modalities and including them into the EBRT plan. Main points of interest encompass differences in target coverage, brain volume receiving 12 Gy or more (V(12)), and doses to various organs-at-risk (OARs). RESULTS: Seventeen pre-delivered treatment plans were included in the study. The mean GTV was 21.72 cm(3) (SD ± 19.36) and mGTV 29.64 cm(3) (SD ± 25.64). The mean EBRT and SRS PTV were 254.09 (SD ± 80.0) and 36.20 cm(3) (SD ± 31.48), respectively. Eight SRS plans were calculated to 15 Gy according to larger tumor sizes, while all IORT plans to 20 Gy. The mean EBRT D(95) was 97.13% (SD ± 3.48) the SRS D(99) 99.91% (SD ± 0.35) and IORT D(90) 83.59% (SD ± 3.55). Accounting for only-boost approaches, the brain V(12) was 49.68 cm(3) (SD ± 26.70) and 16.94 cm(3) (SD ± 13.33) (p<0.001) for SRS and IORT, respectively. After adding EBRT results respectively to SRS and IORT doses, significant lower doses were found in the latter for mean D(max) of chiasma (p=0.01), left optic nerve (p=0.023), right (p=0.008) and left retina (p<0.001). No significant differences were obtained for brainstem and cochleae. CONCLUSION: Dose escalation for Glioblastoma using IORT results in lower OAR exposure as conventional SRS.
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spelling pubmed-85813602021-11-12 Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma Sarria, Gustavo R. Smalec, Zuzanna Muedder, Thomas Holz, Jasmin A. Scafa, Davide Koch, David Garbe, Stephan Schneider, Matthias Hamed, Motaz Vatter, Hartmut Herrlinger, Ulrich Giordano, Frank A. Schmeel, Leonard Christopher Front Oncol Oncology PURPOSE: To simulate and analyze the dosimetric differences of intraoperative radiotherapy (IORT) or pre-operative single-fraction stereotactic radiosurgery (SRS) in addition to post-operative external beam radiotherapy (EBRT) in Glioblastoma (GB). METHODS: Imaging series of previously treated patients with adjuvant radiochemotherapy were analyzed. For SRS target definition, pre-operative MRIs were co-registered to planning CT scans and a pre-operative T1-weighted gross target volume (GTV) plus a 2-mm planning target volume (PTV) were created. For IORT, a modified (m)GTV was expanded from the pre-operative volume, in order to mimic a round cavity as during IORT. Dose prescription was 20 Gy, homogeneously planned for SRS and calculated at the surface for IORT, to cover 99% and 90% of the volumes, respectively. For tumors > 2cm in maximum diameter, a 15 Gy dose was prescribed. Plan assessment was performed after calculating the 2-Gy equivalent doses (EQD2) for both boost modalities and including them into the EBRT plan. Main points of interest encompass differences in target coverage, brain volume receiving 12 Gy or more (V(12)), and doses to various organs-at-risk (OARs). RESULTS: Seventeen pre-delivered treatment plans were included in the study. The mean GTV was 21.72 cm(3) (SD ± 19.36) and mGTV 29.64 cm(3) (SD ± 25.64). The mean EBRT and SRS PTV were 254.09 (SD ± 80.0) and 36.20 cm(3) (SD ± 31.48), respectively. Eight SRS plans were calculated to 15 Gy according to larger tumor sizes, while all IORT plans to 20 Gy. The mean EBRT D(95) was 97.13% (SD ± 3.48) the SRS D(99) 99.91% (SD ± 0.35) and IORT D(90) 83.59% (SD ± 3.55). Accounting for only-boost approaches, the brain V(12) was 49.68 cm(3) (SD ± 26.70) and 16.94 cm(3) (SD ± 13.33) (p<0.001) for SRS and IORT, respectively. After adding EBRT results respectively to SRS and IORT doses, significant lower doses were found in the latter for mean D(max) of chiasma (p=0.01), left optic nerve (p=0.023), right (p=0.008) and left retina (p<0.001). No significant differences were obtained for brainstem and cochleae. CONCLUSION: Dose escalation for Glioblastoma using IORT results in lower OAR exposure as conventional SRS. Frontiers Media S.A. 2021-10-28 /pmc/articles/PMC8581360/ /pubmed/34778080 http://dx.doi.org/10.3389/fonc.2021.759873 Text en Copyright © 2021 Sarria, Smalec, Muedder, Holz, Scafa, Koch, Garbe, Schneider, Hamed, Vatter, Herrlinger, Giordano and Schmeel https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Sarria, Gustavo R.
Smalec, Zuzanna
Muedder, Thomas
Holz, Jasmin A.
Scafa, Davide
Koch, David
Garbe, Stephan
Schneider, Matthias
Hamed, Motaz
Vatter, Hartmut
Herrlinger, Ulrich
Giordano, Frank A.
Schmeel, Leonard Christopher
Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma
title Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma
title_full Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma
title_fullStr Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma
title_full_unstemmed Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma
title_short Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma
title_sort dosimetric comparison of upfront boosting with stereotactic radiosurgery versus intraoperative radiotherapy for glioblastoma
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8581360/
https://www.ncbi.nlm.nih.gov/pubmed/34778080
http://dx.doi.org/10.3389/fonc.2021.759873
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