Comparison of different target volume delineation strategies based on recurrence patterns in adjuvant radiotherapy for glioblastoma

Author:

Yilmaz Melek Tugce1ORCID,Kahvecioglu Alper1,Yedekci Fazli Yagiz1,Yigit Ecem1,Ciftci Gokcen Coban2,Kertmen Neyran3,Zorlu Faruk1,Yazici Gozde1ORCID

Affiliation:

1. Department of Radiation Oncology, Faculty of Medicine, Hacettepe University , Ankara , Turkey

2. Radiology Department, Faculty of Medicine, Hacettepe University , Ankara , Turkey

3. Department of Medical Oncology, Faculty of Medicine, Hacettepe University , Ankara , Turkey

Abstract

Abstract Background Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) recommendations are commonly used guidelines for adjuvant radiotherapy in glioblastoma. In our institutional protocol, we delineate T2-FLAIR alterations as gross target volume (GTV) with reduced clinical target volume (CTV) margins. We aimed to present our oncologic outcomes and compare the recurrence patterns and planning parameters with EORTC and RTOG delineation strategies. Methods Eighty-one patients who received CRT between 2014 and 2021 were evaluated retrospectively. EORTC and RTOG delineations performed on the simulation computed tomography and recurrence patterns and planning parameters were compared between delineation strategies. Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM, Armonk, NY, USA) was utilized for statistical analyses. Results Median overall survival and progression-free survival were 21 months and 11 months, respectively. At a median 18 month follow-up, of the 48 patients for whom recurrence pattern analysis was performed, recurrence was encompassed by only our institutional protocol’s CTV in 13 (27%) of them. For the remaining 35 (73%) patients, recurrence was encompassed by all separate CTVs. In addition to the 100% rate of in-field recurrence, the smallest CTV and lower OAR doses were obtained by our protocol. Conclusions The current study provides promising results for including the T2-FLAIR alterations to the GTV with smaller CTV margins with impressive survival outcomes without any marginal recurrence. The fact that our protocol did not result in larger irradiated brain volume is further encouraging in terms of toxicity.

Publisher

Oxford University Press (OUP)

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