Evaluation of peritumoral edema in the delineation of radiotherapy clinical target volumes for glioblastoma
Evaluation of peritumoral edema in the delineation of radiotherapy clinical target volumes for glioblastoma
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DOI：
10.1016/j.ijrobp.2006.12.009
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发表时间：
2007-05-01
影响因子：
7
通讯作者：
Maor, Moshe H.
中科院分区：
文献类型：
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作者：
Chang, Eric L.;Akyurek, Serap;Maor, Moshe H.
目的：为了评估肿瘤周围水肿和复发模式的患者与胶质母细胞瘤（GBM）之间的空间关系：48原发性GBM患者接受三维适形放疗，并没有故意包括2000年7月至2001年6月之间的临床靶体积瘤周水肿。所有48例患者随后均复发，其原始治疗计划参数用于本研究。根据放射治疗肿瘤学组（RTOG）的靶区勾画指南（规定纳入瘤周水肿），为相同的48例患者创建了新的理论放射治疗计划。靶体积和复发性肿瘤覆盖率，以及正常脑照射的体积百分比，进行了评估，两种方法的目标划定使用剂量体积histograms.Results：复发性肿瘤的位置和瘤周水肿的体积从所有48例之间的比较未能显示相关性的线性回归模型（r（2）= 0.0007，p = 0.3）。对于水肿> 75 cm（3）的患者，在治疗计划中有意包括瘤周水肿的患者与未包括瘤周水肿的患者相比，接受46戈伊照射的脑体积百分比显著更大（38% vs. 31%; p = 0.003）。失败的模式是相同的两套计划（40中央，3在外地，3边缘，和2个遥远的复发）。结论：临床靶体积划定的基础上，2厘米的利润率，而不是瘤周水肿似乎没有改变GBM患者的失败的中央模式。对于瘤周水肿> 75 cm的患者（3），与相应的故意包括瘤周水肿的理论RTOG计划相比，使用恒定的2 cm边缘导致接受30戈伊、46戈伊和50戈伊照射的脑体积百分比中位数更小。(c)2007年爱思唯尔公司
Purpose: To evaluate the spatial relationship between peritumoral edema and recurrence pattern in patients with glioblastoma (GBM).Methods and Materials: Forty-eight primary GBM patients received three-dimensional conformal radiotherapy that did not intentionally include peritumoral edema within the clinical target volume between July 2000 and June 2001. All 48 patients have subsequently recurred, and their original treatment planning parameters were used for this study. New theoretical radiation treatment plans were created for the same 48 patients, based on Radiation Therapy Oncology Group (RTOG) target delineation guidelines that specify inclusion of peritumoral edema. Target volume and recurrent tumor coverage, as well as percent volume of normal brain irradiated, were assessed for both methods of target delineation using dose-volume histograms.Results: A comparison between the location of recurrent tumor and peritumoral edema volumes from all 48 cases failed to show correlation by linear regression modeling (r(2) = 0.0007; p = 0.3). For patients with edema > 75 cm(3), the percent volume of brain irradiated to 46 Gy was significantly greater in treatment plans that intentionally included peritumoral edema compared with those that did not (38% vs. 31%; p = 0.003). The pattern of failure was identical between the two sets of plans (40 central, 3 in-field, 3 marginal, and 2 distant recurrence).Conclusion: Clinical target volume delineation based on a 2-cm margin rather than on peritumoral edema did not seem to alter the central pattern of failure for patients with GBM. For patients with peritumoral edema > 75 cm(3), using a constant 2-cm margin resulted in a smaller median percent volume of brain being irradiated to 30 Gy, 46 Gy, and 50 Gy compared with corresponding theoretical RTOG plans that deliberately included peritumoral edema. (c) 2007 Elsevier Inc.