Influence of volumetric modulated arc therapy and FET-PET scanning on treatment outcomes for glioblastoma patients. (January 2019)

• Record Type: Journal Article
• Authors: Munck af Rosenschold, P.; Law, I.; Engelholm, S.; Engelholm, S.A.; Muhic, A.; Lundemann, M.J.; Roed, H.; Grunnet, K.; Skovgaard Poulsen, H.
• Is Part Of: Radiotherapy and oncology. Volume 130(2019)
• Page Start: 149
• Page End: 155
• Publication Date: 2019-01
• Subjects: Glioblastoma -- Radiotherapy -- FET-PET -- VMAT -- IGRT -- Technology; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2018.10.003
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: A large cohort of glioblastoma patients receiving chemo-radiation therapy was studied. The survival outcomes (PFS and OS) was unaffected by CRT, IG-VMAT and FET-PET technology. Larger mean brain dose was strongly associated with inferior PFS and inferior OS. 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 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.