Influence of volumetric modulated arc therapy and FET-PET scanning on treatment outcomes for glioblastoma patients.
Radiother Oncol
; 130: 149-155, 2019 01.
Article
em En
| MEDLINE
| ID: mdl-30446316
ABSTRACT
BACKGROUND:
We sought to assess the influence of the clinical introduction of new radiotherapy technologies on glioblastoma patients' outcomes.METHODS:
Newly diagnosed glioblastoma patients treated with 60â¯Gy and temozolomide (2005-2014) were analyzed. The patients' GTV and CTV were defined based on MR (nâ¯=â¯521) or FET-PET/MR (nâ¯=â¯190), and were treated using conformal radiotherapy (CRT, nâ¯=â¯159) or image-guided volumetric modulated arc therapy with hippocampal sparing (IG-VMAT, nâ¯=â¯362). Progression-free survival (PFS) was assessed using the McDonald criteria. Associations between clinical data, dosimetry data, treatment technology, for PFS and overall survival (OS) were explored.RESULTS:
The PFS (7â¯months) and OS (15â¯months) were unaffected by CRT, IG-VMAT and FET-PET technology. Mean brain dose was correlated with tumor volume, and was lower for IG-VMAT vs. CRT (pâ¯<â¯0.001). Larger mean brain dose was associated with inferior PFS (univariate/multivariate Cox models, pâ¯<â¯0.001) and OS (univariate, pâ¯<â¯0.001). Multivariate Cox models revealed association of larger mean brainstem dose (pâ¯<â¯0.001), BTV (pâ¯=â¯0.045), steroid use at baseline (pâ¯=â¯0.003), age (pâ¯=â¯0.019) and MGMT status (pâ¯=â¯0.022) with lower OS.CONCLUSIONS:
Introduction of hippocampal-sparing IG-VMAT technology appeared to be safe, and may have reduced toxicity and cognitive impairment. Larger mean brain dose was strongly associated with inferior PFS and OS.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Tirosina
/
Neoplasias Encefálicas
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Glioblastoma
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Tomografia por Emissão de Pósitrons
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Radioterapia de Intensidade Modulada
Tipo de estudo:
Prognostic_studies
Limite:
Adult
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Humans
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Middle aged
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article