Impact of Clinical Target Volume Margin Reduction in Glioblastoma Patients Treated with Concurrent Chemoradiation

Overview

Journal Neurooncol Pract

Publisher Oxford University Press

Date 2024 May 13

PMID 38737612

Authors

Dario Di Perri

David Hofstede

Dianne Hartgerink

Karin Terhaag

Ruud Houben

Alida A Postma

Ann Hoeben

Monique Anten

Linda Ackermans

Inge Compter

Danielle B P Eekers

Affiliations

Soon will be listed here.

Abstract

Background: Glioblastoma (GBM) is widely treated using large radiotherapy margins, resulting in substantial irradiation of the surrounding cerebral structures. In this context, the question arises whether these margins could be safely reduced. In 2018, clinical target volume (CTV) expansion was reduced in our institution from 20 to 15 mm around the gross target volume (GTV) (ie, the contrast-enhancing tumor/cavity). We sought to retrospectively analyze the impact of this reduction.

Methods: All adult patients with GBM treated between January 2015 and December 2020 with concurrent chemoradiation (60Gy/2Gy or 59.4Gy/1.8Gy) were analyzed. Patients treated using a 20 (CTV, = 57) or 15 mm (CTV, = 56) CTV margin were compared for target volumes, dose parameters to the surrounding organs, pattern of recurrence, and survival outcome.

Results: Mean GTV was similar in both groups (ie, CTV: 39.7cm; CTV: 37.8cm; = .71). Mean CTV and PTV were reduced from 238.9cm to 176.7cm ( = .001) and from 292.6cm to 217.0cm ( < .001), for CTV and CTV, respectively. As a result, average brain mean dose (D) was reduced from 25.2Gy to 21.0Gy ( = .002). Significantly lower values were also observed for left hippocampus D, brainstem D, cochleas D, and pituitary D. Pattern of recurrence was similar, as well as patient outcome, ie, median progression-free survival was 8.0 and 7.0 months ( = .80), and median overall survival was 11.0 and 14.0 months ( = .61) for CTV and CTV, respectively.

Conclusions: In GBM patients treated with chemoradiation, reducing the CTV margin from 20 to 15 mm appears to be safe and offers the potential for less treatment toxicity.

Citing Articles

Target delineation for glioblastoma-Is it time to sever historical ties?.

Lo S, Tseng C, Sahgal A Neurooncol Pract. 2024; 11(3):221-222.

PMID: 38737605 PMC: 11085843. DOI: 10.1093/nop/npae013.

References

Davis F, Smith T, Gittleman H, Ostrom Q, Kruchko C, Barnholtz-Sloan J . Glioblastoma incidence rate trends in Canada and the United States compared with England, 1995-2015. Neuro Oncol. 2019; 22(2):301-302. PMC: 7032629. DOI: 10.1093/neuonc/noz203. View

Raschke F, Witzmann K, Seidlitz A, Wesemann T, Jentsch C, Platzek I . Time- and dose-dependent volume decreases in subcortical grey matter structures of glioma patients after radio(chemo)therapy. Clin Transl Radiat Oncol. 2022; 36:99-105. PMC: 9363945. DOI: 10.1016/j.ctro.2022.07.003. View

Eekers D, t Ven L, Roelofs E, Postma A, Alapetite C, Burnet N . The EPTN consensus-based atlas for CT- and MR-based contouring in neuro-oncology. Radiother Oncol. 2018; 128(1):37-43. DOI: 10.1016/j.radonc.2017.12.013. View

Niyazi M, Brada M, Chalmers A, Combs S, Erridge S, Fiorentino A . ESTRO-ACROP guideline "target delineation of glioblastomas". Radiother Oncol. 2016; 118(1):35-42. DOI: 10.1016/j.radonc.2015.12.003. View

McDonald M, Shu H, Curran Jr W, Crocker I . Pattern of failure after limited margin radiotherapy and temozolomide for glioblastoma. Int J Radiat Oncol Biol Phys. 2010; 79(1):130-6. DOI: 10.1016/j.ijrobp.2009.10.048. View

Compter I, Eekers D, Hoeben A, Rouschop K, Reymen B, Ackermans L . Chloroquine combined with concurrent radiotherapy and temozolomide for newly diagnosed glioblastoma: a phase IB trial. Autophagy. 2020; 17(9):2604-2612. PMC: 8496728. DOI: 10.1080/15548627.2020.1816343. View

Matsuyama T, Fukugawa Y, Kuroda J, Toya R, Watakabe T, Matsumoto T . A prospective comparison of adaptive and fixed boost plans in radiotherapy for glioblastoma. Radiat Oncol. 2022; 17(1):40. PMC: 8864825. DOI: 10.1186/s13014-022-02007-4. View

Niyazi M, Andratschke N, Bendszus M, Chalmers A, Erridge S, Galldiks N . ESTRO-EANO guideline on target delineation and radiotherapy details for glioblastoma. Radiother Oncol. 2023; 184:109663. DOI: 10.1016/j.radonc.2023.109663. View

Guram K, Smith M, Ginader T, Bodeker K, Pelland D, Pennington E . Using Smaller-Than-Standard Radiation Treatment Margins Does Not Change Survival Outcomes in Patients with High-Grade Gliomas. Pract Radiat Oncol. 2018; 9(1):16-23. PMC: 6487873. DOI: 10.1016/j.prro.2018.06.001. View

10.

Wen P, Macdonald D, Reardon D, Cloughesy T, Sorensen A, Galanis E . Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol. 2010; 28(11):1963-72. DOI: 10.1200/JCO.2009.26.3541. View

11.

Nagtegaal S, David S, van Grinsven E, van Zandvoort M, Seravalli E, Snijders T . Morphological changes after cranial fractionated photon radiotherapy: Localized loss of white matter and grey matter volume with increasing dose. Clin Transl Radiat Oncol. 2021; 31:14-20. PMC: 8416633. DOI: 10.1016/j.ctro.2021.08.010. View

12.

Stewart J, Sahgal A, Lee Y, Soliman H, Tseng C, Detsky J . Quantitating Interfraction Target Dynamics During Concurrent Chemoradiation for Glioblastoma: A Prospective Serial Imaging Study. Int J Radiat Oncol Biol Phys. 2020; 109(3):736-746. DOI: 10.1016/j.ijrobp.2020.10.002. View

13.

Kruser T, Bosch W, Badiyan S, Bovi J, Ghia A, Kim M . NRG brain tumor specialists consensus guidelines for glioblastoma contouring. J Neurooncol. 2019; 143(1):157-166. PMC: 6483830. DOI: 10.1007/s11060-019-03152-9. View

14.

Haldbo-Classen L, Amidi A, Lukacova S, Wu L, Von Oettingen G, Lassen-Ramshad Y . Cognitive impairment following radiation to hippocampus and other brain structures in adults with primary brain tumours. Radiother Oncol. 2020; 148:1-7. DOI: 10.1016/j.radonc.2020.03.023. View

15.

Minniti G, Amelio D, Amichetti M, Salvati M, Muni R, Bozzao A . Patterns of failure and comparison of different target volume delineations in patients with glioblastoma treated with conformal radiotherapy plus concomitant and adjuvant temozolomide. Radiother Oncol. 2010; 97(3):377-81. DOI: 10.1016/j.radonc.2010.08.020. View

16.

Haldbo-Classen L, Amidi A, Wu L, Lukacova S, Oettingen G, Lassen-Ramshad Y . Associations between patient-reported outcomes and radiation dose in patients treated with radiation therapy for primary brain tumours. Clin Transl Radiat Oncol. 2021; 31:86-92. PMC: 8515293. DOI: 10.1016/j.ctro.2021.09.006. View

17.

Minniti G, Tini P, Giraffa M, Capone L, Raza G, Russo I . Feasibility of clinical target volume reduction for glioblastoma treated with standard chemoradiation based on patterns of failure analysis. Radiother Oncol. 2022; 181:109435. DOI: 10.1016/j.radonc.2022.11.024. View

18.

Weller M, van den Bent M, Preusser M, Le Rhun E, Tonn J, Minniti G . EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol. 2020; 18(3):170-186. PMC: 7904519. DOI: 10.1038/s41571-020-00447-z. View

19.

Gebhardt B, Dobelbower M, Ennis W, Bag A, Markert J, Fiveash J . Patterns of failure for glioblastoma multiforme following limited-margin radiation and concurrent temozolomide. Radiat Oncol. 2014; 9:130. PMC: 4055938. DOI: 10.1186/1748-717X-9-130. View

20.

Kumar N, Kumar R, Sharma S, Mukherjee A, Khandelwal N, Tripathi M . Impact of volume of irradiation on survival and quality of life in glioblastoma: a prospective, phase 2, randomized comparison of RTOG and MDACC protocols. Neurooncol Pract. 2020; 7(1):86-93. PMC: 7104885. DOI: 10.1093/nop/npz024. View