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Seaberg MH, Kazda T, Youland RS, Laack NN, Pafundi DH, Anderson SK, Sarkaria JN, Galanis E, Brown PD, Brinkmann DH. Dosimetric patterns of failure in the era of novel chemoradiotherapy in newly-diagnosed glioblastoma patients. Radiother Oncol 2023; 188:109768. [PMID: 37385378 DOI: 10.1016/j.radonc.2023.109768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 06/09/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Patterns of failure (POF) may provide an alternative quantitative endpoint to overall survival for evaluation of novel chemoradiotherapy regimens with glioblastoma. MATERIALS AND METHODS POF of 109 newly-diagnosed glioblastoma patients per 2016 WHO classification who received conformal radiotherapy with concomitant and adjuvant temozolomide were reviewed. Seventy-five of those patients also received an investigational chemotherapy agent (everolimus, erlotinib, or vorinostat). Recurrence volumes were defined with MRI contrast enhancement. POF at protocol (POFp), initial (POFi), and RANO (POFRANO) progression timepoints were characterized by the percentage of recurrence volume within the 95% dose region. POFp, POFi, and POFRANO of each patient were categorized (central, non-central, or both). RESULTS POF of the temozolomide-only control cohort were unchanged (79% central, 12% non-central, and 9% both) across protocol, initial, and RANO progression timepoints. Unlike the temozolomide-only cohort, POF of the collective novel chemotherapy cohort appeared increasingly non-central when comparing POFi with POFp, with a non-central component increasing from 16% to 29% (p = 0.078). POF did not correlate with overall survival or time to progression. CONCLUSION POF of patients receiving a novel chemotherapy appeared to be influenced by the timepoint of analysis and were increasingly non-central at protocol progression as compared with initial recurrence, suggesting that recurrence originates from the central region. Addition of everolimus and vorinostat appeared to influence POF, despite similar survival outcomes with the temozolomide-only control group. In studies dealing with novel therapeutic agents, robust and properly-timed dosimetric POF analysis may be helpful to evaluate biologic aspects of novel agents.
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Affiliation(s)
- Maasa H Seaberg
- University of California San Francisco Medical Center, Department of Radiation Oncology, San Francisco, CA, USA
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | | | - Nadia N Laack
- Mayo Clinic, Department of Radiation Oncology, Rochester, MN, USA
| | - Deanna H Pafundi
- Mayo Clinic, Department of Radiation Oncology, Jacksonville, FL, USA
| | | | - Jann N Sarkaria
- Mayo Clinic, Department of Radiation Oncology, Rochester, MN, USA
| | | | - Paul D Brown
- Mayo Clinic, Department of Radiation Oncology, Rochester, MN, USA
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Guberina N, Padeberg F, Pöttgen C, Guberina M, Lazaridis L, Jabbarli R, Deuschl C, Herrmann K, Blau T, Wrede KH, Keyvani K, Scheffler B, Hense J, Layer JP, Glas M, Sure U, Stuschke M. Location of Recurrences after Trimodality Treatment for Glioblastoma with Respect to the Delivered Radiation Dose Distribution and Its Influence on Prognosis. Cancers (Basel) 2023; 15:cancers15112982. [PMID: 37296942 DOI: 10.3390/cancers15112982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
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.
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Affiliation(s)
- Nika Guberina
- Department of Radiation Therapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Florian Padeberg
- Department of Radiation Therapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Christoph Pöttgen
- Department of Radiation Therapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Maja Guberina
- Department of Radiation Therapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Lazaros Lazaridis
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Tobias Blau
- Institute of Neuropathology, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery and Spine Surgery, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Kathy Keyvani
- Institute of Neuropathology, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Björn Scheffler
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
- DKFZ-Division Translational Neurooncology at the West German Cancer Center (WTZ), DKTK Partner Site, University Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Jörg Hense
- Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Julian P Layer
- Department of Radiation Oncology, University of Bonn, University Hospital Bonn, 53127 Bonn, Germany
- Institute of Experimental Oncology, University of Bonn, University Hospital Bonn, 53127 Bonn, Germany
| | - Martin Glas
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Martin Stuschke
- Department of Radiation Therapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
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3
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Niyazi M, Andratschke N, Bendszus M, Chalmers AJ, Erridge SC, Galldiks N, Lagerwaard FJ, Navarria P, Munck Af Rosenschöld P, Ricardi U, van den Bent MJ, Weller M, Belka C, Minniti G. ESTRO-EANO guideline on target delineation and radiotherapy details for glioblastoma. Radiother Oncol 2023; 184:109663. [PMID: 37059335 DOI: 10.1016/j.radonc.2023.109663] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND AND PURPOSE Target delineation in glioblastoma is still a matter of extensive research and debate. This guideline aims to update the existing joint European consensus on delineation of the clinical target volume (CTV) in adult glioblastoma patients. MATERIAL AND METHODS The ESTRO Guidelines Committee identified 14 European experts in close interaction with the ESTRO clinical committee and EANO who discussed and analysed the body of evidence concerning contemporary glioblastoma target delineation, then took part in a two-step modified Delphi process to address open questions. RESULTS Several key issues were identified and are discussed including i) pre-treatment steps and immobilisation, ii) target delineation and the use of standard and novel imaging techniques, and iii) technical aspects of treatment including planning techniques and fractionation. Based on the EORTC recommendation focusing on the resection cavity and residual enhancing regions on T1-sequences with the addition of a reduced 15 mm margin, special situations are presented with corresponding potential adaptations depending on the specific clinical situation. CONCLUSIONS The EORTC consensus recommends a single clinical target volume definition based on postoperative contrast-enhanced T1 abnormalities, using isotropic margins without the need to cone down. A PTV margin based on the individual mask system and IGRT procedures available is advised; this should usually be no greater than 3 mm when using IGRT.
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Affiliation(s)
- Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Munich, Germany.
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Sara C Erridge
- Edinburgh Centre for Neuro-Oncology, University of Edinburgh, Western General Hospital, Edinburgh, EH4 1EU, UK
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany; Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Frank J Lagerwaard
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Per Munck Af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, and Lund University, Lund, Sweden
| | | | | | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Giuseppe Minniti
- Dept. of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
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Ghosh S, Johanns TM, Chheda MG, Liu E, Butt O, Abraham C, Badiyan S, Huang Y, DeNardo D, Kim AH, Hallahan D, Thotala D, Huang J. A pilot phase Ib study to evaluate tadalafil to overcome immunosuppression during chemoradiotherapy for IDH-wild-type glioblastoma. Neurooncol Adv 2023; 5:vdad088. [PMID: 37554225 PMCID: PMC10406429 DOI: 10.1093/noajnl/vdad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Background Myeloid-derived suppressor cells (MDSCs) are critical regulators of immunosuppression and radioresistance in glioblastoma (GBM). The primary objective of this pilot phase Ib study was to validate the on-target effect of tadalafil on inhibiting MDSCs in peripheral blood and its safety when combined with chemoradiotherapy in GBM patients. Methods Patients with newly diagnosed IDH-wild-type GBM received radiation therapy (RT) and temozolomide (TMZ) combined with oral tadalafil for 2 months. A historical cohort of 12 GBM patients treated with RT and TMZ was used as the comparison group. The ratio of MDSCs, T cells, and cytokines at week 6 of RT compared to baseline were analyzed using flow cytometry. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method. Results Tadalafil was well tolerated with no dose-limiting toxicity among 16 evaluable patients. The tadalafil cohort had a significantly lower ratio of circulating MDSCs than the control: granulocytic-MDSCs (mean 0.78 versus 3.21, respectively, P = 0.01) and monocytic-MDSCs (1.02 versus 1.96, respectively, P = 0.006). Tadalafil increased the CD8 ratio compared to the control (1.99 versus 0.70, respectively, P < 0.001), especially the PD-1-CD8 T cells expressing Ki-67, CD38, HLA-DR, CD28, and granzyme B. Proinflammatory cytokine IL-1β was also significantly increased after tadalafil compared to the control. The tadalafil cohort did not have significantly different PFS and OS than the historical control. Conclusions Concurrent tadalafil is well tolerated during chemoradiotherapy for GBM. Tadalafil is associated with a reduction of peripheral MDSCs after chemoradiotherapy and increased CD8 T-cell proliferation and activation.
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Affiliation(s)
- Subhajit Ghosh
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Radiation Oncology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Tanner M Johanns
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St Louis, Missouri, USA
- Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Milan G Chheda
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St Louis, Missouri, USA
- Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric Liu
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Omar Butt
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St Louis, Missouri, USA
- Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christopher Abraham
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA
- Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Shahed Badiyan
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA
- Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Yi Huang
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA
| | - David DeNardo
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA
- Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dennis Hallahan
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA
- Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dinesh Thotala
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Radiation Oncology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jiayi Huang
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA
- Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
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Yao Y, Tan X, Yin W, Kou Y, Wang X, Jiang X, Chen S, Liu Y, Dang J, Yin J, Cheng Z. Performance of 18 F-FAPI PET/CT in assessing glioblastoma before radiotherapy: a pilot study. BMC Med Imaging 2022; 22:226. [PMID: 36566187 PMCID: PMC9789562 DOI: 10.1186/s12880-022-00952-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We aimed to determine the performance of 18 F-FAPI PET/CT used for preprocedural assessment of glioblastoma before radiotherapy. METHODS Twelve glioblastoma patients having undergone incomplete surgical resection or biopsy were examined with 18 F-FAPI PET/CT and MRI scanning before radiotherapy. All patients had confirmed tumor residues according to findings of histopathological and/or long-term clinical and radiological follow-ups. Lesion characterization data, including SUVmax and tumor-to-background ratio (TBR) on PET/CT were attained. PET/CT and MRI findings were compared in terms of number of lesions. The correlation between immunohistochemistry, molecular expression, and PET/CT parameters was also evaluated. RESULTS 18 F-FAPI PET/CT detected 16 FAPI-avid out of 23 lesions in 12 patients described on MRI. MRI was statistically different from 18 F-FAPI PET/CT for lesion detection according to the exact McNemar statistical test (P = 0.0156). The SUVmax and TBR of the glioblastomas was 7.08 ± 3.55 and 19.95 ± 13.22, respectively. The sensitivity and positive predictive value (PPV) of 18 F-FAPI PET were 69.6% and 100%, respectively. Neither the Ki-67 index nor the molecular expression was correlated with the FAPI-PET/CT parameters. CONCLUSION 18 F-FAPI PET/CT detects glioblastomas at a lower rate than MRI. However, the 100% PPV of the examination may make it useful for differentiating controversial lesions detected on MRI. The 18 F-FAPI-avid lesions are displayed more clearly probably due to a higher TBR. 18 F-FAPI PET/CT imaging might find application in glioblastoma biopsy and radiotherapy planning.
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Affiliation(s)
- Yutang Yao
- grid.54549.390000 0004 0369 4060Department of Nuclear Medicine, Sichuan Cancer Hospital&Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, No.55, Section 4, South People’s Road, Sichuan 610041 Chengdu, China
| | - Xiaofei Tan
- grid.54549.390000 0004 0369 4060Department of Nuclear Medicine, Sichuan Cancer Hospital&Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, No.55, Section 4, South People’s Road, Sichuan 610041 Chengdu, China
| | - Wenya Yin
- grid.54549.390000 0004 0369 4060Department of Radiation Oncology, Sichuan Cancer Hospital&Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, No.55, Section 4, South People’s Road, 610041 Chengdu, China
| | - Ying Kou
- grid.54549.390000 0004 0369 4060Department of Nuclear Medicine, Sichuan Cancer Hospital&Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, No.55, Section 4, South People’s Road, Sichuan 610041 Chengdu, China
| | - Xiaoxiong Wang
- grid.54549.390000 0004 0369 4060Department of Nuclear Medicine, Sichuan Cancer Hospital&Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, No.55, Section 4, South People’s Road, Sichuan 610041 Chengdu, China
| | - Xiao Jiang
- grid.54549.390000 0004 0369 4060Department of Nuclear Medicine, Sichuan Cancer Hospital&Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, No.55, Section 4, South People’s Road, Sichuan 610041 Chengdu, China ,grid.410655.30000 0001 0157 8259Institute of Isotope, China Institute of Atomic Energy, 102413 Beijing, China
| | - Shirong Chen
- grid.54549.390000 0004 0369 4060Department of Nuclear Medicine, Sichuan Cancer Hospital&Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, No.55, Section 4, South People’s Road, Sichuan 610041 Chengdu, China
| | - Yongli Liu
- grid.54549.390000 0004 0369 4060Department of Nuclear Medicine, Sichuan Cancer Hospital&Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, No.55, Section 4, South People’s Road, Sichuan 610041 Chengdu, China
| | - Jun Dang
- grid.54549.390000 0004 0369 4060Department of Nuclear Medicine, Sichuan Cancer Hospital&Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, No.55, Section 4, South People’s Road, Sichuan 610041 Chengdu, China
| | - Jun Yin
- grid.54549.390000 0004 0369 4060Department of Radiation Oncology, Sichuan Cancer Hospital&Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, No.55, Section 4, South People’s Road, 610041 Chengdu, China
| | - Zhuzhong Cheng
- grid.54549.390000 0004 0369 4060Department of Nuclear Medicine, Sichuan Cancer Hospital&Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, No.55, Section 4, South People’s Road, Sichuan 610041 Chengdu, China
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Kraus RD, Weil CR, Frances Su FC, Cannon DM, Burt LM, Mendez JS. Incidence and extent of disease progression on MRI between surgery and initiation of radiotherapy in glioblastoma patients. Neurooncol Pract 2022; 9:380-389. [PMID: 36134015 PMCID: PMC9476988 DOI: 10.1093/nop/npac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background A post-operative MRI (MRIpost-op) performed within 72 h is routinely used for radiation treatment planning in glioblastoma (GBM) patients, with radiotherapy starting about 4-6 weeks after surgery. Some patients undergo an additional pre-radiotherapy MRI (MRIpre-RT) about 2-6 weeks after surgery. We sought to analyze the incidence of rapid early progression (REP) between surgery and initiation of radiotherapy seen on MRIpre-RT and the impact on radiation target volumes. Methods Patients with GBM diagnosed between 2018 and 2020 who had an MRIpost-op and MRIpre-RT were retrospectively identified. Criteria for REP was based on Modified RANO criteria. Radiation target volumes were created and compared using the MRIpost-op and MRIpre-RT. Results Fifty patients met inclusion criteria. The median time between MRIpost-op and MRIpre-RT was 26 days. Indications for MRIpre-RT included clinical trial enrollment in 41/50 (82%), new symptoms in 5/50 (10%), and unspecified in 4/50 (8%). REP was identified in 35/50 (70%) of patients; 9/35 (26%) had disease progression outside of the MRIpost-op-based high dose treatment volumes. Treatment planning with MRIpost-op yielded a median undertreatment of 27.1% of enhancing disease and 11.2% of surrounding subclinical disease seen on MRIpre-RT. Patients without REP had a 38% median volume reduction of uninvolved brain if target volumes were planned with MRIpre-RT. Conclusion Given the incidence of REP and its impact on treatment volumes, we recommend using MRIpre-RT for radiation treatment planning to improve coverage of gross and subclinical disease, allow for early identification of REP, and decrease radiation treatment volumes in patients without REP.
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Affiliation(s)
- Ryan D Kraus
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Christopher R Weil
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Fan-Chi Frances Su
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Donald M Cannon
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Lindsay M Burt
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Joe S Mendez
- Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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