Patterns of failure and comparison of different target volume delineations in patients with glioblastoma treated with conformal radiotherapy plus concomitant and adjuvant temozolomide
Patterns of failure and comparison of different target volume delineations in patients with glioblastoma treated with conformal radiotherapy plus concomitant and adjuvant temozolomide
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DOI：
10.1016/j.radonc.2010.08.020
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发表时间：
2010-12-01
影响因子：
5.7
通讯作者：
Enrici, Riccardo Maurizi
中科院分区：
文献类型：
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作者：
Minniti, Giuseppe;Amelio, Dante;Enrici, Riccardo Maurizi
目的：分析新诊断的胶质母细胞瘤（GBM）适形放疗（RT）联合替莫唑胺（TMZ）和辅助治疗的复发模式，并根据不同的靶体积划分比较失败的模式。方法与材料：对105例经三维适形放射治疗+ TMZ治疗后复发的GBM患者进行评价。根据欧洲癌症研究和治疗组织（EORTC）最近的随机试验，用于我们治疗计划（S'Andrea计划）的临床靶体积（CTV）包括残余肿瘤和切除腔加上2厘米边缘。MRI扫描显示肿瘤复发与计划计算机断层扫描（CT）融合。使用剂量-体积直方图对失效模式进行剂量学分析。对于每位患者，根据放射治疗肿瘤组（RTOG）的现行指南，创建了基于术后水肿加2厘米边缘的理论计划，并评估了失败的模式。结果：中位总生存期和无进展生存期分别为14.2个月和7.5个月。79例为中心复发，6例为局部复发，6例为边缘复发，14例为远处复发。对O(6)-甲基鸟嘌呤- dna甲基转移酶（MGMT）启动子甲基化状态的分析显示，MGMT甲基化患者与MGMT未甲基化患者的GBMs复发模式不同。复发发生率分别为64%和31%的甲基化患者和91%和5.4%的未甲基化患者（P = 0.01）。不同治疗方案之间的失败模式相似，但我们的方案中高剂量脑辐照的中位体积百分比明显小于RTOG方案（P = 0.0001）。结论：大多数接受放射治疗加伴随和辅助放射治疗的患者有中枢性复发，但超过10%的患者可能出现远处新病变。与包括水肿扩大的方案相比，使用术后残余肿瘤和腔加上2厘米边缘的靶标划定与高剂量照射下正常脑体积更小有关，而边缘复发的风险没有显著增加。未来的临床随机研究需要比较不同的计划方法的疗效和后期辐射毒性的风险。2010爱思唯尔爱尔兰有限公司版权所有。放射治疗与肿瘤学97 (2010)377-381
Purpose: To analyze the recurrence patterns in patients with newly diagnosed glioblastoma (GBM) treated with conformal radiotherapy (RT) plus concomitant and adjuvant temozolomide (TMZ), and to compare the patterns of failure according to different target volume delineations.Methods and materials: One hundred and five patients with GBM which recurred after three-dimensional (3D) conformal RT plus TMZ were evaluated. The clinical target volume (CTV) used for our treatment planning (S'Andrea plans) consisted of residual tumor and resection cavity plus 2-cm margins according to recent randomized trials of the European Organisation for Research and Treatment of Cancer (EORTC). MRI scans showing tumor recurrences were fused with the planning computed tomography (CT). and the patterns of failure were analyzed dosimetrically using dose-volume histograms. For each patient a theoretical plan based on the addition of postoperative edema plus 2-cm margins according to current guidelines of Radiation Therapy Oncology Group (RTOG) was created and patterns of failure were evaluated.Results: The median overall survival and progression-free survival were 14.2 months and 7.5 months, respectively. Recurrences were central in 79 patients, in-field in 6 patients, marginal in 6 patients, and distant in 14 patients. Analysis of O(6)-methylguanine-DNA-methyltransferase (MGMT) promoter methylation status showed different recurrence patterns of GBMs in patients with MGMT methylated compared with patients with MGMT unmethylated status. Recurrences occurred central/in-field and outside in 64% and 31% of methylated patients, and in 91% and 5.4% of unmethylated patients, respectively (P = 0.01). Patterns of failure were similar between the different treatment plans, however the median volume percent of brain irradiated to high doses was significantly smaller for our plans than for RTOG plans (P = 0.0001). Conclusion: Most of patients treated with RT plus concomitant and adjuvant RI have central recurrences, however distant new lesions may occur in more than 10% of patients. The use of target delineation using postoperative residual tumor and cavity plus 2-cm margins is associated with smaller volumes of normal brain irradiated to high doses as compared with plans including expanded edema, without a significant increase of the risk of marginal recurrences. Future clinical randomized studies need to compare the different planning methods in terms of efficacy and risk of late radiation-induced toxicity. (C) 2010 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 97 (2010) 377-381