Objectives: Glioblastoma (GBM) radiotherapy (RT) target delineation requires MRI, ideally concurrent with CT simulation (pre-RT MRI). Due to limited MRI availability, <72 h post-surgery MRI is commonly used instead. Whilst previous investigations assessed volumetric differences between post-surgical and pre-RT delineations, dosimetric impact remains unknown. We quantify volumetric and dosimetric impact of using post-surgical MRI for GBM target delineation. Methods: Gross tumour volumes (GTVs) for five GBM patients receiving chemo-RT with post-surgical and pre-RT MRIs were delineated by three independent observers. Planning target volumes (PTVs) and RT plans were generated for each GTV. Volumetric and dosimetric differences were assessed through: absolute volumes, volume-distance histograms and dose-volume histogram statistics. Results: Post-surgical MRI delineations had significantly (p < 0.05) larger GTV and PTV volumes (median 16.7 and 64.4 cm3, respectively). Post-surgical RT plans, applied to pre-RT delineations, had significantly decreased (p < 0.01) median PTV doses (ΔD99% = −8.1 Gy and ΔD95% = −2.0 Gy). Median organ-at-risk (OAR) dose increases (brainstem ΔD5% =+0.8, normal brain mean dose =+2.9 and normal brain ΔD10% = 5.3 Gy) were observed. Conclusion: Post-surgical MRI delineation significantly impacted RT planning, with larger normal-appearing tissue volumes irradiated and increased OAR doses, despite a reduced coverage of the pre-RT defined target. Advances in knowledge: We believe this is the first investigation assessing the dosimetric impact of using post-surgical MRI for GBM target delineation. It highlights the potential of significantly degraded RT plans, showing the clinical need for dedicated MRI for GBM RT.

Conclusion: CAS incidence is high after head and neck radiotherapy, gradually rising over time. No clear dose-response effect between carotid dose and CAS was identified. Carotid artery screening and preventative strategies should be employed in this patient population.

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