TY - JOUR
T1 - Influence of volumetric modulated arc therapy and FET-PET scanning on treatment outcomes for glioblastoma patients
AU - Munck af Rosenschold, P.
AU - Law, I.
AU - Engelholm, S.
AU - Engelholm, S. A.
AU - Muhic, A.
AU - Lundemann, M. J.
AU - Roed, H.
AU - Grunnet, K.
AU - Skovgaard Poulsen, H.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
KW - FET-PET
KW - Glioblastoma
KW - IGRT
KW - Radiotherapy
KW - Technology
KW - VMAT
U2 - 10.1016/j.radonc.2018.10.003
DO - 10.1016/j.radonc.2018.10.003
M3 - Article
C2 - 30446316
AN - SCOPUS:85056392126
SN - 0167-8140
VL - 130
SP - 149
EP - 155
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -