Feasibility and Outcomes of Hypofractionated Simultaneous Integrated Boost-Intensity Modulated Radiotherapy for Malignant Gliomas: A Preliminary Report
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Purpose: The aim of this study was to assess the feasibility and efficacy of hypofractionated simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) using three-layered planning target volumes (PTV) for malignant gliomas. Materials and Methods: We conducted a retrospective analysis of 12 patients (WHO grade IV-10; III-2) postoperatively treated with SIB-IMRT with concurrent temozolomide. Three-layered PTVs were contoured based on gadolinium-enhanced magnetic resonance imaging as follows; high risk PTV (H-PTV) as the area of surgical bed including residual gross tumor with a 0.5 cm margin; low risk PTV (L-PTV) as the area surrounding the high risk PTV with 1.5 cm margin; moderate risk PTV (M-PTV) as a line at one-third the distance from high risk PTV to low risk PTV. Total dose to high risk PTV was 70 Gy in 8 and 62.5 Gy in 4 patients. Results: The median follow-up time was 52 months in surviving patients. The 2- and 5-year overall survival (OS) rates were 66.6% and 47.6%, respectively. The 2- and 5-year progression-free survival (PFS) rates were 57.1% and 45.7%, respectively. The median OS and PFS were 48 and 31 months, respectively. Six patients (50%) progressed: in-field only in one, out-field or disseminated in 4, and both in one patient. All patients completed planned treatments without a toxicity-related gap. Asymptomatic radiation necrosis was observed in 4 patients at post-radiotherapy 9-31 months. Conclusion: An escalated dose of hypofractionated SIB-IMRT using three-layered PTVs can be safely performed in patients with malignant glioma, and might contribute to better tumor control and survival.
Abstract
Purpose: The aim of this study was to assess the feasibility and efficacy of hypofractionated simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) using three-layered planning target volumes (PTV) for malignant gliomas. Materials and Methods: We conducted a retrospective analysis of 12 patients (WHO grade IV-10; III-2) postoperatively treated with SIB-IMRT with concurrent temozolomide. Three-layered PTVs were contoured based on gadolinium-enhanced magnetic resonance imaging as follows; high risk PTV (H-PTV) as the area of surgical bed including residual gross tumor with a 0.5 cm margin; low risk PTV (L-PTV) as the area surrounding the high risk PTV with 1.5 cm margin; moderate risk PTV (M-PTV) as a line at one-third the distance from high risk PTV to low risk PTV. Total dose to high risk PTV was 70 Gy in 8 and 62.5 Gy in 4 patients. Results: The median follow-up time was 52 months in surviving patients. The 2- and 5-year overall survival (OS) rates were 66.6% and 47.6%, respectively. The 2- and 5-year progression-free survival (PFS) rates were 57.1% and 45.7%, respectively. The median OS and PFS were 48 and 31 months, respectively. Six patients (50%) progressed: in-field only in one, out-field or disseminated in 4, and both in one patient. All patients completed planned treatments without a toxicity-related gap. Asymptomatic radiation necrosis was observed in 4 patients at post-radiotherapy 9-31 months. Conclusion: An escalated dose of hypofractionated SIB-IMRT using three-layered PTVs can be safely performed in patients with malignant glioma, and might contribute to better tumor control and survival.
참고문헌 (26)
- Lee SW, "Patterns of failure following high-dose 3-D conformal radiotherapy for high-grade astrocytomas: a quantitative dosimetric study", Int J Radiat Oncol Biol Phys, 43, pp.79~88 (1999)
- Selker RG, "The Brain Tumor Cooperative Group NIH Trial 87-01: a randomized comparison of surgery, external radiotherapy, and carmustine versus surgery, interstitial radiotherapy boost, external radiation therapy, and carmustine", Neurosurgery, 51, pp.343~355 (2002)
- Prados MD, "Phase III trial of accelerated hyperfractionation with or without difluromethylornithine (DFMO) versus standard fractionated radiotherapy with or without DFMO for newly diagnosed patients with glioblastoma multiforme", Int J Radiat Oncol Biol Phys, 49, pp.71~77 (2001)
- Souhami L, "Randomized comparison of stereotactic radiosurgery followed by conventional radiotherapy with carmustine to conventional radiotherapy with carmustine for patients with glioblastoma multiforme: report of Radiation Therapy Oncology Group 93-05 protocol", Int J Radiat Oncol Biol Phys, 60, pp.853~860 (2004)
- MacDonald SM, "Intensity modulated radiation therapy versus three-dimensional conformal radiation therapy for the treatment of high grade glioma: a dosimetric comparison", J Appl Clin Med Phys, 8, pp.47~60 (2007)
- Chan MF, "Comparison of intensity-modulated radiotherapy with three-dimensional conformal radiation therapy planning for glioblastoma multiforme", Med Dosim, 28, pp.261~265 (2003)
- Hall EJ, "Radiobiology for the radiologist. 7th ed", pp.2012, Wolters Kluwer Health
- Apuzzo MLJ, "Malignant cerebral glioma" (1990), American Association of Neurological Surgeons
- Phillips TL, "Leibel and Phillips textbook of radiation oncology. 3rd ed", pp.2010, Elsevier
- Stupp R, "Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide", J Clin Oncol, 20, pp.1375~1382 (2002)
- Haas-Kogan DA, "p53-dependent G1 arrest and p53-independent apoptosis influence the radiobiologic response of glioblastoma", Int J Radiat Oncol Biol Phys, 36, pp.95~103 (1996)
- Chan JL, "Survival and failure patterns of high-grade gliomas after three-dimensional conformal radiotherapy", J Clin Oncol, 20, pp.1635~1642 (2002)
- Narayana A, "Intensity-modulated radiotherapy in high-grade gliomas: clinical and dosimetric results", Int J Radiat Oncol Biol Phys, 64, pp.892~897 (2006)
- Floyd NS, "Hypofractionated intensity-modulated radiotherapy for primary glioblastoma multiforme", Int J Radiat Oncol Biol Phys, 58, pp.721~726 (2004)
- Iuchi T, "Hypofractionated high-dose irradiation for the treatment of malignant astrocytomas using simultaneous integrated boost technique by IMRT", Int J Radiat Oncol Biol Phys, 64, pp.1317~1324 (2006)
- Stupp R, "Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma", N Engl J Med, 352, pp.987~996 (2005)
- Stupp R, "Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial", Lancet Oncol, 10, pp.459~466 (2009)
- Cao JQ, "Hypofractionated radiotherapy with or without concurrent temozolomide in elderly patients with glioblastoma multiforme: a review of ten-year single institutional experience", J Neurooncol, 107, pp.395~405 (2012)
- Yang X, "Radiosensitivity, recovery and dose-rate effect in three human glioma cell lines", Radiother Oncol, 19, pp.49~56 (1990)
- Shibamoto Y, "Comparison of accelerated hyperfractionated radiotherapy and conventional radiotherapy for supratentorial malignant glioma", Jpn J Clin Oncol, 27, pp.31~36 (1997)
- Romanelli P, "Role of stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of recurrent glioblastoma multiforme", Neurosurg Focus, 27, pp.E8~ (2009)
- Irwin C, "Delay in radiotherapy shortens survival in patients with high grade glioma", J Neurooncol, 85, pp.339~343 (2007)
- Burnet NG, "Mathematical modelling of survival of glioblastoma patients suggests a role for radiotherapy dose escalation and predicts poorer outcome after delay to start treatment", Clin Oncol (R Coll Radiol), 18, pp.93~103 (2006)
- Kim YS, "MGMT gene promoter methylation as a potent prognostic factor in glioblastoma treated with temozolomide-based chemoradiotherapy: a single-institution study", Int J Radiat Oncol Biol Phys, 84, pp.661~667 (2012)
- Suzuki M, "Feasibility study of the simultaneous integrated boost (SIB) method for malignant gliomas using intensity-modulated radiotherapy (IMRT)", Jpn J Clin Oncol, 33, pp.271~277 (2003)
- Franken NA, "Clonogenic assay of cells in vitro", Nat Protoc, 1, pp.2315~2319 (2006)