ESTRO ACROP guideline for target volume delineation of skull base tumors

Combs, Stephanie E.; Baumert, Brigitta G.; Bendszus, Martin; Bozzao, Alessandro; Brada, Michael; Fariselli, Laura; Fiorentino, Alba; Ganswindt, Ute; Grosu, Anca L.; Lagerwaard, F.; Niyazi, Maximilian; Nyholm, Tufve; Paddick, Ian; Weber, Damien Charles; Belka, Claus; Minniti, Giuseppe

doi:10.1016/j.radonc.2020.11.014

Cited by 70 publications

(54 citation statements)

References 169 publications

(157 reference statements)

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“…In case of local recurrence, the initial target volumes, proposed growth areas, and the recurrent tumor tissue received a dose within the ICRU50 prescription of 60.0 Gy in 3/7 cases whereas also the other 4/7 received at least 50.0 Gy, owing to a lower prescribed dose of 54.0 Gy or OARs and corresponding to 88% of a prescribed dose of 60.0 Gy [ 21 ]. Margin definition for CTV and PTV in our cohort was in line with recommendations for extended margins in atypical meningioma with a recommended CTV margin of 15 mm around the GTV [ 10 , 22 ]. In all patients with relapse, the growth zone was covered by the initial PTV and received a minimal dose of 50.25 Gy and the PTV received an EUD of at least 51.40 Gy.…”

Section: Discussionsupporting

confidence: 69%

Retrospective analysis of recurrence patterns and clinical outcome of grade II meningiomas following postoperative radiotherapy

et al. 2021

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Background Atypical meningiomas exhibit a high tendency for tumor recurrence even after multimodal therapy. Information regarding recurrence patterns after additive radiotherapy is scarce but could improve radiotherapy planning and therapy decision. We conducted an analysis of recurrence patterns with regard to target volumes and dose coverage assessing target volume definition and postulated areas of tumor re-growth origin. Prognostic factors contributing to relapse were evaluated. Methods The clinical outcome of patients who had completed additive, somatostatin receptor (SSTR)-PET/CT-based fractionated intensity-modulated radiotherapy for atypical meningioma between 2007 and 2017 was analyzed. In case of tumor recurrence/progression, treatment planning was evaluated for coverage of the initial target volumes and the recurrent tumor tissue. We proposed a model evaluating the dose distribution in postulated areas of tumor re-growth origin. The median of proliferation marker MIB-1 was assessed as a prognostic factor for local progression and new distant tumor lesions. Results Data from 31 patients who had received adjuvant (n = 11) or salvage radiotherapy (n = 20) were evaluated. Prescribed dose ranged from 54.0 to 60.0 Gy. Local control at five years was 67.9%. Analysis of treatment plans of the eight patients experiencing local failure proved sufficient extent of target volumes and coverage of the prescribed dose of at least 50.0 Gy as determined by mean dose, D98, D2, and equivalent uniform dose (EUD) of all initial target volumes, postulated growth-areas, and areas of recurrent tumor tissue. In all cases, local failure occurred in high-dose volumes. Tumors with a MIB-1 expression above the median (8%) showed a higher tendency for re-growth. Conclusions The model showed adequate target volume and relative dose distribution but absolute dose appears lower in recurrent tumors without reaching statistical significance. This might provide a rationale for dose escalation studies. Biological factors such as MIB-1 might aid patients’ stratification for dose escalation.

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Section: Discussionsupporting

confidence: 69%

Retrospective analysis of recurrence patterns and clinical outcome of grade II meningiomas following postoperative radiotherapy

et al. 2021

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“…In 2018, the European Particle Therapy Network (EPTN) presented a consensus-based contouring atlas for CT-and MR-based contouring in Neuro-Oncology [1,2]. This atlas is available online and is now being used internationally by radiation oncologists (RTOs) and radiation therapy technologists (RTTs) in daily practice, as well as for research purposes [3][4][5][6]. Since this time, the search for organs at risk (OARs) associated with toxicity has continued [7,8].…”

Section: Discussionmentioning

confidence: 99%

“…The aim of this atlas is to reduce OARs delineation variability between RTOs/RTTs and between radiotherapy centres, both in photon and in particle therapy. Similarly, guidelines aiming at harmonising target volume delineation in the field of neuro-oncology have been recently published for glioblastoma [32] and skull base tumours [3]. Importantly, uniform delineation is a prerequisite for the implementation of large-scale clinical trials in the field of neuro-oncology, as well as for the accumulation of uniform toxicity data.…”

Section: Discussionmentioning

confidence: 99%

Update of the EPTN atlas for CT- and MR-based contouring in Neuro-Oncology

Eekers

Perri

Roelofs

et al. 2021

Radiotherapy and Oncology

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“…In patients without surgery and for Grade I benign meningioma, the CTV was identical to the GTV. For Grade II and III meningiomas, the CTV was usually defined as 1–2 cm margin added to the GTV [ 9 ]. When the tumor was located near an organ at risk, we reduced the expansion of the CTV margin near the area of the tumor that was close to the organ at risk.…”

Section: Methodsmentioning

confidence: 99%

Effect of osteoporotic conditions on the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma

et al. 2021

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Purpose Disruption of the tumor-brain barrier in meningioma is a crucial factor in peritumoral brain edema (PTBE). We previously reported the possible effect of osteoporosis on the integrity of the arachnoid trabeculae because both the bone and the arachnoid trabeculae are composed of type 1 collagen. We hypothesized that osteoporotic conditions may be associated with PTBE occurrence after radiation treatment in patients with meningioma. Methods A receiver operating characteristic curve analysis was used to identify the optimal cut-off values of mean skull Hounsfield unit for predicting osteopenia and osteoporosis in patients from our registry. Multivariate Cox regression analysis was used to determine whether possible osteoporosis independently predicted PTBE development in patients with meningioma after radiation. Results A total of 106 intracranial meningiomas were included for the study. All patients received linear accelerator-based radiation therapy in our hospital over an approximate 6-year period. Multivariate Cox regression analysis identified that hypothetical osteoporosis was an independent predictive factor for the development of PTBE in patients with meningioma after linear accelerator-based radiation treatment (hazard ratio 5.20; 95% confidence interval 1.11–24.46; p = 0.037). Conclusions Our study suggests that possible osteoporotic conditions may affect PTBE development after linear accelerator-based radiation treatment for intracranial meningioma. However, due to the study’s small number of patients, these findings need to be validated in future studies with larger cohorts, before firm recommendations can be made. Graphic abstract

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ESTRO ACROP guideline for target volume delineation of skull base tumors

Cited by 70 publications

References 169 publications

Retrospective analysis of recurrence patterns and clinical outcome of grade II meningiomas following postoperative radiotherapy

Retrospective analysis of recurrence patterns and clinical outcome of grade II meningiomas following postoperative radiotherapy

Update of the EPTN atlas for CT- and MR-based contouring in Neuro-Oncology

Effect of osteoporotic conditions on the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma

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