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Influence of volumetric modulated arc therapy and FET-PET scanning on treatment outcomes for glioblastoma patients

Munck af Rosenschold, P. LU orcid ; Law, I. ; Engelholm, S. ; Engelholm, S. A. ; Muhic, A. ; Lundemann, M. J. ; Roed, H. ; Grunnet, K. and Skovgaard Poulsen, H. (2019) In Radiotherapy and Oncology 130. p.149-155
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 60 Gy and temozolomide (2005–2014) were analyzed. The patients’ GTV and CTV were defined based on MR (n = 521) or FET-PET/MR (n = 190), and were treated using conformal radiotherapy (CRT, n = 159) or image-guided volumetric modulated arc therapy with hippocampal sparing (IG-VMAT, n = 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 (7 months) and OS (15 months) were... (More)

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 60 Gy and temozolomide (2005–2014) were analyzed. The patients’ GTV and CTV were defined based on MR (n = 521) or FET-PET/MR (n = 190), and were treated using conformal radiotherapy (CRT, n = 159) or image-guided volumetric modulated arc therapy with hippocampal sparing (IG-VMAT, n = 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 (7 months) and OS (15 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 (p < 0.001). Larger mean brain dose was associated with inferior PFS (univariate/multivariate Cox models, p < 0.001) and OS (univariate, p < 0.001). Multivariate Cox models revealed association of larger mean brainstem dose (p < 0.001), BTV (p = 0.045), steroid use at baseline (p = 0.003), age (p = 0.019) and MGMT status (p = 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.

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author
; ; ; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
FET-PET, Glioblastoma, IGRT, Radiotherapy, Technology, VMAT
in
Radiotherapy and Oncology
volume
130
pages
7 pages
publisher
Elsevier
external identifiers
  • scopus:85056392126
  • pmid:30446316
ISSN
0167-8140
DOI
10.1016/j.radonc.2018.10.003
language
English
LU publication?
no
id
39840209-8084-4e2b-8df2-165c42e2a47a
date added to LUP
2020-07-28 08:38:00
date last changed
2024-05-30 21:15:43
@article{39840209-8084-4e2b-8df2-165c42e2a47a,
  abstract     = {{<p>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 60 Gy and temozolomide (2005–2014) were analyzed. The patients’ GTV and CTV were defined based on MR (n = 521) or FET-PET/MR (n = 190), and were treated using conformal radiotherapy (CRT, n = 159) or image-guided volumetric modulated arc therapy with hippocampal sparing (IG-VMAT, n = 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 (7 months) and OS (15 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 (p &lt; 0.001). Larger mean brain dose was associated with inferior PFS (univariate/multivariate Cox models, p &lt; 0.001) and OS (univariate, p &lt; 0.001). Multivariate Cox models revealed association of larger mean brainstem dose (p &lt; 0.001), BTV (p = 0.045), steroid use at baseline (p = 0.003), age (p = 0.019) and MGMT status (p = 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.</p>}},
  author       = {{Munck af Rosenschold, P. and Law, I. and Engelholm, S. and Engelholm, S. A. and Muhic, A. and Lundemann, M. J. and Roed, H. and Grunnet, K. and Skovgaard Poulsen, H.}},
  issn         = {{0167-8140}},
  keywords     = {{FET-PET; Glioblastoma; IGRT; Radiotherapy; Technology; VMAT}},
  language     = {{eng}},
  month        = {{01}},
  pages        = {{149--155}},
  publisher    = {{Elsevier}},
  series       = {{Radiotherapy and Oncology}},
  title        = {{Influence of volumetric modulated arc therapy and FET-PET scanning on treatment outcomes for glioblastoma patients}},
  url          = {{http://dx.doi.org/10.1016/j.radonc.2018.10.003}},
  doi          = {{10.1016/j.radonc.2018.10.003}},
  volume       = {{130}},
  year         = {{2019}},
}