Intensity-modulated proton therapy, volumetric-modulated arc therapy, and 3D conformal radiotherapy in anaplastic astrocytoma and glioblastoma

Adeberg, Sebastian; Harrabi, Semi; Bougatf, Nina; Bernhardt, Denise; Rieber, Juliane; Koerber, Stefan A.; Syed, Mustafa; Sprave, Tania; Mohr, A.; Abdollahi, Amir; Haberer, Thomas; Combs, Stephanie E.; Herfarth, Klaus; Debus, Jürgen; Rieken, Stefan

doi:10.1007/s00066-016-1007-7

Cited by 47 publications

(29 citation statements)

References 45 publications

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“…19 However, with improved RT target volume delineation, more narrow margin expansion into normal brain, and improved dose distribution of IMRT, the late deficits may be less evident with RT. 20 Data support the association between RT dosimetry and late effects. RT dose per fraction was reported to be a predictor of late neurocognitive deficits in patients with low-grade glioma.…”

Section: Discussionsupporting

confidence: 53%

Reflecting on survivorship outcomes to aid initial decision making in patients treated for IDH‐mutated anaplastic glioma

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Jayamanne

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et al. 2019

Cancer

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BACKGROUND: Patients with anaplastic glioma (AG) harboring an isocitrate dehydrogenase mutation have potential durable survival after intensity-modulated radiotherapy (IMRT) and chemotherapy. Understanding long-term functioning, and the factors that have an impact on later effects, is important for decision making. METHODS: Consecutive patients with AG who received IMRT were reviewed with regard to 6 survivorship domains, including Eastern Cooperative Oncology Group (ECOG) performance status, Medical Research Council (MRC) neurological status, late toxicity, comorbidity, functional status (employment/driving), and psychosocial events. Assessments were performed at baseline before RT; at month +6; and at years +1, +3, and +5 after RT. The primary endpoints were ECOG at year +3 and employment at year +3. RESULTS: A total of 146 patients were included, with a median follow-up of 5.1 years. The 6-year overall survival rate was 78.7% (95% CI, 71.1%-87.0%). Baseline ECOG performance status was 0 to 1 in 82.2% of patients but improved at year +1 (95.7%) and year +3 (97.2%). Employment rates at year +3 and year +5 were 70.1% and 76.5%, respectively, compared with 61.6% at baseline. Worse ECOG performance status at year +3 was related to the anaplastic astrocytoma subtype (P = .001), delayed RT (P = .081), multiple craniotomies performed before RT (P = .002), worse ECOG performance status before RT (P < .001), worse MRC neurological status before RT (P < .001), seizures (P = .038), neurocognitive disturbance (P < .001), and the presence of recurrent disease (P = .004). Absent or impaired employment at year +3 was found to be related to older age (P = .007), delayed timing of RT (P = .023), multiple craniotomies prior to RT (P = .005), worse ECOG performance status before RT (P < .001), worse MRC neurological status before RT (P < .001), and neurocognitive disturbance (P < .001). CONCLUSIONS: Patients with AG with an isocitrate dehydrogenase mutation have the potential for prolonged survival. Functional status appears to be good in patients who are free of disease progression at 3 to 5 years after IMRT, with >95% of patients having high ECOG performance status and >75% being employed. Cancer 2019;125:3457-3466.

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Section: Discussionsupporting

confidence: 53%

Reflecting on survivorship outcomes to aid initial decision making in patients treated for IDH‐mutated anaplastic glioma

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Jayamanne

Back³

et al. 2019

Cancer

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“…[8,[10][11][12][13] In previous comparative studies for 3D-CRT and/or IMRT and/or VMAT, preoperative and postoperative MRI, only postoperative MRI, varying clinical target volume margins, varying dose schedules (including simultaneous integrated boost) have been used for target volume delineation. [6][7][8][9]12,[14][15][16][17][18][19] As emphasized in the guidelines for RT for glioblastoma published by the American Society for Radiation Oncology in March 2016, four main target delineations of different cooperative groups (single-phase treatment or two-phase treatment volume, involving or not involving edema) exist, and these are defined by the postoperative MRI but have different target definitions. [2] We aimed to investigate the effects of 3D-CRT, IMRT, and VMAT treatment plans on the doses of OARs, by using European Organisation for Research and Treatment of Cancer-Advisory Committee on Radiation Oncology Practise (EORTC-ACROP) target delineation, which has not been evaluated previously.…”

Section: Resultsmentioning

confidence: 99%

“…Adeberg et al compared IM proton therapy (PRT), VMAT, and 3D-CRT treatment plans in 12 patients with high-grade glial tumors. [15] They used a volume definition containing tumor cavity and edema in postoperative MRI. Compared with 3D-CRT and VMAT, PRT showed a statistically significant dose reduction in whole-brain mean dose, brainstem, pituitary gland, contralateral hippocampus, and contralateral subventricular zone.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Three-Dimensional Conformal Radiation Therapy, Intensity-Modulated Radiation Therapy, and Volumetric- Modulated Arc Therapy In Glioblastoma Multiforme Radiation Therapy With EORTC Target Delineation

İbiş¹

2018

TJ Oncol

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In this study, three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated RT (IMRT), and volumetric-modulated arc therapy (VMAT) techniques were compared in patients with glioblastoma multiforme (GBM) receiving RT. Comparisons were made in terms of sparing the organs at risk (OAR), by using European Organisation for Research and Treatment of Cancer-Advisory Committee on Radiation Oncology Practise (EORTC-ACROP) guideline. METHODS RT in 10 patients was replanned. Treatment volume was created according to the EORTC-ACROP, and 60 Gy/30 fraction dose was prescribed for planning target volume (PTV). PTV-less brain volume (B-PTV) Dmean, OARs doses; V5Gy and V50Gy of B-PTV volumes; conformality, and homogeneity indices were analyzed. RESULTS B-PTV was spared better in IMRT. The optic chiasm, contralateral optic nerve, ipsilateral/contralateral cochlea were significantly spared in IMRT and VMAT. The best sparing for brainstem, pituitary gland, ipsilateral eye, ipsilateral lacrimal gland was obtained with VMAT. B-PTV volume received at least 5 Gy was similar in three plans, but lower with 50 Gy in IMRT and VMAT (p<0.001). Although homogenous dose distribution was obtained with similar homogeneity index in all three planning techniques, conformity index was the best in VMAT (p<0.001). CONCLUSION VMAT provides improved conformity index and good homogeneity in GBM RT using the EORTC-ACROP target and dose definition. The best sparing for OAR was obtained with VMAT.

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“…This is especially important in children whose brain is very sensitive to irradiation (as discussed above). An essential dose reduction by using PBT compared to conformal radiotherapy was shown particularly in contralaterally located critical neuronal structures (61). Different clinical studies measured superior quality of life, physical, and IQ scores in children with brain tumors receiving PBT compared to those treated with X-rays (62–65).…”

Section: Radiation-induced Late Brain Injuriesmentioning

confidence: 99%

Ionizing Radiation-Induced Immune and Inflammatory Reactions in the Brain

2017

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Radiation-induced late brain injury consisting of vascular abnormalities, demyelination, white matter necrosis, and cognitive impairment has been described in patients subjected to cranial radiotherapy for brain tumors. Accumulating evidence suggests that various degrees of cognitive deficit can develop after much lower doses of ionizing radiation, as well. The pathophysiological mechanisms underlying these alterations are not elucidated so far. A permanent deficit in neurogenesis, chronic microvascular alterations, and blood–brain barrier dysfunctionality are considered among the main causative factors. Chronic neuroinflammation and altered immune reactions in the brain, which are inherent complications of brain irradiation, have also been directly implicated in the development of cognitive decline after radiation. This review aims to give a comprehensive overview on radiation-induced immune alterations and inflammatory reactions in the brain and summarizes how these processes can influence cognitive performance. The available data on the risk of low-dose radiation exposure in the development of cognitive impairment and the underlying mechanisms are also discussed.

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Intensity-modulated proton therapy, volumetric-modulated arc therapy, and 3D conformal radiotherapy in anaplastic astrocytoma and glioblastoma

Cited by 47 publications

References 45 publications

Reflecting on survivorship outcomes to aid initial decision making in patients treated for IDH‐mutated anaplastic glioma

Reflecting on survivorship outcomes to aid initial decision making in patients treated for IDH‐mutated anaplastic glioma

Comparison of Three-Dimensional Conformal Radiation Therapy, Intensity-Modulated Radiation Therapy, and Volumetric- Modulated Arc Therapy In Glioblastoma Multiforme Radiation Therapy With EORTC Target Delineation

Ionizing Radiation-Induced Immune and Inflammatory Reactions in the Brain

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