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GBM Olgularında Adjuvan Radyoterapi Sonrası Nüks Paterninin Doz Dağılımı ile İlişkisi: EORTC ve RTOG Kılavuzlarının Değerlendirilmesi

Year 2020, Volume: 27 Issue: 4, 447 - 454, 25.12.2020
https://doi.org/10.17343/sdutfd.672273

Abstract

Amaç:
Çalışmamızın amacı glioblastoma multiforme (GBM) tanısı ile adjuvan radyoterapi (RT) eş zamanlı temozolamid uygulanmış olan hastalarda nüks paterninin doz dağılımı ile ilişkisinin değerlendirilmesidir. Buna ek olarak çalışma sonuçlarının ışığında GBM olgularında RT hedef volümlerinin belirlenmesinde kullanılan European Organisation for Research and Treatment of Cancer (EORTC) ve Radiation Therapy Oncology Group (RTOG) kılavuzları tartışılması amaçlandı.

Gereç ve Yöntem:
Kliniğimizde, biyopsi veya cerrahi eksizyon sonrası GBM tanısı almış ve Ekim 2011 – Haziran 2018 tarihleri arasında adjuvan RT eş zamanlı temozolamid uygulanmış 31 hasta çalışmaya alındı. Radyoterapi 22 hastaya 3 boyutlu konformal 9 hastaya ise yoğunluk ayarlı RT tekniği kullanılarak ile 46 Gy (Faz I) sonrası 14 Gy boost (Faz II) olmak üzere toplam 60 Gy şeklinde uygulandı. Hastaların radyoterapi öncesi iki hafta içerisinde çekilmiş olan MR görüntüleri baz olarak alındı. Tüm hastalara RT eş zamanlı 75mg / kg / gün temozolamid uygulandı. Radyoterapi sonrası 2-3. ay veya sonrasındaki kontrol T1 MR görüntülerinde operasyon kavitesi veya postoperatif rezidüel lezyonun kontrast tutulumunda artış, kontrast tutan volümde artış, T2/FLAIR görüntülerde ödemde artış olan hastalar progresyon olarak değerlendirilirken operasyon kavitesi veya postoperatif rezidüel lezyondan ayrı, yeni gelişen lezyonlar nüks olarak kabul edildi. Nüks lezyonlar uzman radyolog tarafından MR spektroskopi görüntüleri üzerine konturlandı. Bu görüntüler planlama CT görüntüleri ile füzyon yapılarak nüks lezyon alanının retrospektif dozimetrik değerlendirilmesi yapıldı. Dozimetrik incelemede nüks lezyon alanının maksimum, minimum ve ortalama dozları, D95(%95 inin aldığı doz), D50 (%50 sinin aldığı doz), V%95 (planlanan dozun % 95 ini alan volüm) değerlendirildi.

Bulgular:
Çalışmaya alınan 31 hastanın ortalama yaşı 59 yıl (28 -78) olup median takip süresi 17 (5 -64) aydır. Median genel sağkalım 17 (5 - 66) ay olarak bulundu. Operasyon 19 hastada gross total rezeksiyon (GTR), 10 hastada subtotal rezeksiyon (STR) şeklinde olup 2 hasta biyopsi ile tanı almış idi. Bir hasta hariç tüm hastalarda postoperatif MR görüntülerinde rezidü mevcut idi.
Takip süresinde 1 hastada progresyon, 14 hastada nüks saptanırken 16 hastanın stabil olduğu gözlendi. Nüks olan 12 hastada lezyon % 100 PTV60 içinde yer almakta iken kalan iki hastada sırasıyla % 98.7 ve 61.8 oranında PTV 60 içinde idi. Ortalama nüks volümü 11.14 (0.7 – 48) cc olarak bulundu.
Nüks lezyonların ortalama maksimum, minimum ve mean dozları, D95, D50, V%95 sırasıyla 6246 cGy (6043 – 6439), 5805 cGy (3574 – 6098) ,6106 cGy (5906 – 6223), 5941 cGy (4588 – 6162), 6123 cGy (6009 – 6217), 11,04 cc (07 – 48,37) idi.

Sonuç:
Çalışmamızda rekürren lezyonların % 95 oranında PTV 60 içerisinde olduğu görüldü. Bu sonuç baz alındığında, ödem alanını içeren hedef volüme faz I olarak 46 Gy uygulanmasının katkısı tartışmalıdır. Özellikle operasyon kavitesi ve rezidü boyutu büyük olan ve normal doku toksistesinin yüksek olacağı öngörülen hastalarda tek fazlı tedavi tercih edilebilir.

References

  • 1. Ohgaki H, Dessen P, Jourde B, Horstmann S, Nishikawa T, Di Patre PL, et al. Genetic pathways to glioblastoma: a population-based study. Cancer Res 2004;64(19):6892-9.
  • 2. De Angelis LM. Brain tumors. N Engl J Med 2001;344(2):114-23.
  • 3. Buckner JC. Factors influencing survival in high-grade gliomas. Semin Oncol 2003;30(6 Suppl 19):10-4.
  • 4. Kristiansen K, Hagen S, Kollevold T, Torvik A, Holme I, Nesbakken R, et al. Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: a prospective multicenter trial of the Scandinavian Glioblastoma Study Group. Cancer 1981;47:649–52.
  • 5. Laperriere N, Zuraw L, Cairncross G. Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review. Radiother Oncol 2002;64:259–73.
  • 6. Walker MD, Alexander E Jr, Hunt WE, MacCarty CS, Mahaley MS Jr, Mealey J Jr, et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 1978;49:333–43.
  • 7. Walker MD, Green SB, Byar DP, Alexander E Jr, Batzdorf U, Brooks WH, et al. Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med 1980;303:1323–9.
  • 8. Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTCNCIC trial. Lancet Oncol 2009;10:459–66.
  • 9. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005;352:987–96.
  • 10. Stupp R, Brada M, van den Bent MJ, Tonn JC, Pentheroudakis G. High-grade glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and followup. Ann Oncol 2014;25:93–101
  • 11. Corn BW, Wang M, Fox S, Michalski J, Purdy J, Simpson J, et al. Health related quality of life and cognitive status in patients with glioblastoma multiforme receiving escalating doses of conformal three dimensional radiation on RTOG 98–03. J Neurooncol 2009;95:247–57.
  • 12. Scheibel RS, Meyers CA, Levin VA. Cognitive dysfunction following surgery for intracerebral glioma: influence of histopathology, lesion location, and treatment. J Neurooncol 1996;30:61–9.
  • 13. Ataman F, Poortmans P, Stupp R, Fisher B, Mirimanoff RO. Quality assurance of the EORTC 26981/22981; NCIC CE3 intergroup trial on radiotherapy with or without temozolomide for newly-diagnosed glioblastoma multiforme: the individual case review. Eur J Cancer 2004;40:1724–30.
  • 14. Nelson DF, Curran WJ Jr, Scott C, Nelson JS, Weinstein AS, Ahmad K, et al. Hyperfractionated radiation therapy and bis-chlorethyl nitrosourea in the treatment of malignant glioma—possible advantage observed at 72.0 Gy in 1.2 Gy B.I.D. fractions: Report of the Radiation Therapy Oncology Group Protocol 8302. Int J Radiat Oncol Biol Phys 1993;25:193–207.
  • 15. Urtasun RC, Kinsella TJ, Farnan N, DelRowe JD, Lester SG, Fulton DS. Survival improvement in anaplastic astrocytoma, combining external radiation with halogenated pyrimidines: Final report of RTOG 86-12, Phase I-II study. Int J Radiat Oncol Biol Phys 1996;36:1163–1167.
  • 16. Niyazi M, Brada M, Chalmers AJ, Combs SE, Erridge SC, Fiorentino A, et al. ESTRO-ACROP guideline "target delineation of glioblastomas". Radiother Oncol. 2016 JaBurger PC, Heinz ER, Shibata T, et al. Topographic anatomy and CT correlations in the untreated glioblastoma multiforme.J Neurosurg 1988;68:698 –704.
  • 17. Burger PC, Heinz ER, Shibata T, Kleihues P. Topographic anatomy and CT correlations in the untreated glioblastoma multiforme.J Neurosurg 1988;68:698 –704.
  • 18. Kelly PJ, Daumas-Duport C, Scheithauer BW, Kall BA, Kispert DB. Stereotactic histologic correlations of computed tomographyand magnetic resonance imaging-defined abnormalities in patients with glial neoplasms. Mayo Clin Proc 1987;62: 450 – 459.
  • 19. Halperin EC, Bentel G, Heinz ER, Burger PC. Radiation therapy treatment planning in supratentorial glioblastoma multiforme: An analysis based on post mortem topographic anatomy with CT correlations. Int J Radiat Oncol Biol Phys 1989;17:1347–1350.n;118(1):35-42. doi: 10.1016/j.radonc.2015.12.003
  • 20. Liang BC, Thornton AF Jr, Sandler HM, Greenberg HS. Malignant astrocytomas: Focal tumor recurrence after focal external beam radiation therapy. J Neurosurg 1991;75:559 –563.
  • 21. Hochberg FH, Pruitt A. Assumptions in the radiotherapy of glioblastoma. Neurology 1980;30:907–911.
  • 22. Wallner KE, Galicich JH, Krol G, Arbit E, Malkin MG. Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 1989;16: 1405–1409.
  • 23. Hess CF, Schaaf JC, Kortmann RD, Schabet M, Bamberg M. Malignant glioma: Patterns of failure following individually tailored limited volume irradiation. Radiother Oncol 1994;30:146 –149.
  • 24. Massey V, Wallner KE. Patterns of second recurrence of malignant astrocytomas. Int J Radiat Oncol Biol Phys 1990; 18:395–398
  • 25. Chan JL, Lee SW, Fraass BA, Normolle DP, Greenberg HS, Junck LR, et al. Survival and failure patterns of high-grade gliomas after three-dimensional conformal radiotherapy. J Clin Oncol 2002;20:1635–1642.
  • 26. Barajas RF Jr, Hess CP, Phillips JJ, Von Morze CJ, Yu JP, Chang SM, et al. Super-resolution track density imagingof glioblastoma: histopathologic correlation. AJNR Am J Neuroradiol 2013; 34: 1319-25. [CrossRef]
  • 27. Cha S. Update on brain tumor imaging: from anatomy to physiology. AJNR Am J Neuroradiol 2006; 27: 475-87.
  • 28. Chang EL, Akyurek S, Avalos T, Rebueno N, Spicer C, Garcia J et al. Evaluation of peritumoral edema in the delineation of radiotherapy clinical target volumes for glioblastoma. Int J Radiat Oncol Biol Phys. 2007 May 1;68(1):144-50.
  • 29. Garden AS, Maor MH, Yung WK, Bruner JM, Woo SY, Moser RP, et al. Outcome and patterns of failure following limited-volume irradiation for malignant astrocytomas. Radiother Oncol 1991;20:99 –110.
  • 30. Lee SW1, Fraass BA, Marsh LH, Herbort K, Gebarski SS, Martel MK, et al. Patterns of failure following high-dose 3-D conformal radiotherapy for highgrade astrocytomas: A quantitative dosimetric study. Int J Radiat Oncol Biol Phys 1999;43:79–88.
  • 31. Hochberg FH, Pruitt A. Assumptions in the radiotherapy of glioblastoma. Neurology 1980;30:907–911.
  • 32. Brandsma D, Stalpers L, Taal W, Sminia P, van den Bent MJ. Clinical features, mechanisms, and management of pseudoprogression in malignant gliomas. Lancet Oncol 2008; 9: 453-61
  • 33. Taal W, Brandsma D, de Bruin HG, Bromberg JE, Swaak-Kragten AT, Smitt PA, et al. Incidence of early pseudo-progression in a cohort of malignant glioma patients treated with chemoirradiation with temozolomide. Cancer 2008; 113: 405-10.
  • 34. Haacke EM, Xu Y, Cheng YC, Reichenbach JR. Susceptibility weighted imaging (SWI). Magn Reson Med 2004; 52: 612-8.
  • 35. Rauscher A, Sedlacik J, Barth M, Mentzel HJ, Reichenbach JR. Magnetic susceptibility-weighted MR phase imaging of the human brain. AJNR Am J Neuroradiol 2005; 26: 736-42.
  • 36. Yazol M, Öner A.Y. Beyin Gliomlarında Manyetik Rezonans Görüntüleme Trd Sem 2016; 4: xx
  • 37. Taylor JS, Langston JW, Reddick WE, Kingsley PB, Ogg RJ, Pui MH, et al. Clinical value of proton magnetic resonance spectroscopy for differentiating recurrent or residual brain tumor from delayed cerebral necrosis. Int J Radiat Oncol Biol Phys 1996; 36: 1251-61.
Year 2020, Volume: 27 Issue: 4, 447 - 454, 25.12.2020
https://doi.org/10.17343/sdutfd.672273

Abstract

References

  • 1. Ohgaki H, Dessen P, Jourde B, Horstmann S, Nishikawa T, Di Patre PL, et al. Genetic pathways to glioblastoma: a population-based study. Cancer Res 2004;64(19):6892-9.
  • 2. De Angelis LM. Brain tumors. N Engl J Med 2001;344(2):114-23.
  • 3. Buckner JC. Factors influencing survival in high-grade gliomas. Semin Oncol 2003;30(6 Suppl 19):10-4.
  • 4. Kristiansen K, Hagen S, Kollevold T, Torvik A, Holme I, Nesbakken R, et al. Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: a prospective multicenter trial of the Scandinavian Glioblastoma Study Group. Cancer 1981;47:649–52.
  • 5. Laperriere N, Zuraw L, Cairncross G. Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review. Radiother Oncol 2002;64:259–73.
  • 6. Walker MD, Alexander E Jr, Hunt WE, MacCarty CS, Mahaley MS Jr, Mealey J Jr, et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 1978;49:333–43.
  • 7. Walker MD, Green SB, Byar DP, Alexander E Jr, Batzdorf U, Brooks WH, et al. Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med 1980;303:1323–9.
  • 8. Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTCNCIC trial. Lancet Oncol 2009;10:459–66.
  • 9. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005;352:987–96.
  • 10. Stupp R, Brada M, van den Bent MJ, Tonn JC, Pentheroudakis G. High-grade glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and followup. Ann Oncol 2014;25:93–101
  • 11. Corn BW, Wang M, Fox S, Michalski J, Purdy J, Simpson J, et al. Health related quality of life and cognitive status in patients with glioblastoma multiforme receiving escalating doses of conformal three dimensional radiation on RTOG 98–03. J Neurooncol 2009;95:247–57.
  • 12. Scheibel RS, Meyers CA, Levin VA. Cognitive dysfunction following surgery for intracerebral glioma: influence of histopathology, lesion location, and treatment. J Neurooncol 1996;30:61–9.
  • 13. Ataman F, Poortmans P, Stupp R, Fisher B, Mirimanoff RO. Quality assurance of the EORTC 26981/22981; NCIC CE3 intergroup trial on radiotherapy with or without temozolomide for newly-diagnosed glioblastoma multiforme: the individual case review. Eur J Cancer 2004;40:1724–30.
  • 14. Nelson DF, Curran WJ Jr, Scott C, Nelson JS, Weinstein AS, Ahmad K, et al. Hyperfractionated radiation therapy and bis-chlorethyl nitrosourea in the treatment of malignant glioma—possible advantage observed at 72.0 Gy in 1.2 Gy B.I.D. fractions: Report of the Radiation Therapy Oncology Group Protocol 8302. Int J Radiat Oncol Biol Phys 1993;25:193–207.
  • 15. Urtasun RC, Kinsella TJ, Farnan N, DelRowe JD, Lester SG, Fulton DS. Survival improvement in anaplastic astrocytoma, combining external radiation with halogenated pyrimidines: Final report of RTOG 86-12, Phase I-II study. Int J Radiat Oncol Biol Phys 1996;36:1163–1167.
  • 16. Niyazi M, Brada M, Chalmers AJ, Combs SE, Erridge SC, Fiorentino A, et al. ESTRO-ACROP guideline "target delineation of glioblastomas". Radiother Oncol. 2016 JaBurger PC, Heinz ER, Shibata T, et al. Topographic anatomy and CT correlations in the untreated glioblastoma multiforme.J Neurosurg 1988;68:698 –704.
  • 17. Burger PC, Heinz ER, Shibata T, Kleihues P. Topographic anatomy and CT correlations in the untreated glioblastoma multiforme.J Neurosurg 1988;68:698 –704.
  • 18. Kelly PJ, Daumas-Duport C, Scheithauer BW, Kall BA, Kispert DB. Stereotactic histologic correlations of computed tomographyand magnetic resonance imaging-defined abnormalities in patients with glial neoplasms. Mayo Clin Proc 1987;62: 450 – 459.
  • 19. Halperin EC, Bentel G, Heinz ER, Burger PC. Radiation therapy treatment planning in supratentorial glioblastoma multiforme: An analysis based on post mortem topographic anatomy with CT correlations. Int J Radiat Oncol Biol Phys 1989;17:1347–1350.n;118(1):35-42. doi: 10.1016/j.radonc.2015.12.003
  • 20. Liang BC, Thornton AF Jr, Sandler HM, Greenberg HS. Malignant astrocytomas: Focal tumor recurrence after focal external beam radiation therapy. J Neurosurg 1991;75:559 –563.
  • 21. Hochberg FH, Pruitt A. Assumptions in the radiotherapy of glioblastoma. Neurology 1980;30:907–911.
  • 22. Wallner KE, Galicich JH, Krol G, Arbit E, Malkin MG. Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 1989;16: 1405–1409.
  • 23. Hess CF, Schaaf JC, Kortmann RD, Schabet M, Bamberg M. Malignant glioma: Patterns of failure following individually tailored limited volume irradiation. Radiother Oncol 1994;30:146 –149.
  • 24. Massey V, Wallner KE. Patterns of second recurrence of malignant astrocytomas. Int J Radiat Oncol Biol Phys 1990; 18:395–398
  • 25. Chan JL, Lee SW, Fraass BA, Normolle DP, Greenberg HS, Junck LR, et al. Survival and failure patterns of high-grade gliomas after three-dimensional conformal radiotherapy. J Clin Oncol 2002;20:1635–1642.
  • 26. Barajas RF Jr, Hess CP, Phillips JJ, Von Morze CJ, Yu JP, Chang SM, et al. Super-resolution track density imagingof glioblastoma: histopathologic correlation. AJNR Am J Neuroradiol 2013; 34: 1319-25. [CrossRef]
  • 27. Cha S. Update on brain tumor imaging: from anatomy to physiology. AJNR Am J Neuroradiol 2006; 27: 475-87.
  • 28. Chang EL, Akyurek S, Avalos T, Rebueno N, Spicer C, Garcia J et al. Evaluation of peritumoral edema in the delineation of radiotherapy clinical target volumes for glioblastoma. Int J Radiat Oncol Biol Phys. 2007 May 1;68(1):144-50.
  • 29. Garden AS, Maor MH, Yung WK, Bruner JM, Woo SY, Moser RP, et al. Outcome and patterns of failure following limited-volume irradiation for malignant astrocytomas. Radiother Oncol 1991;20:99 –110.
  • 30. Lee SW1, Fraass BA, Marsh LH, Herbort K, Gebarski SS, Martel MK, et al. Patterns of failure following high-dose 3-D conformal radiotherapy for highgrade astrocytomas: A quantitative dosimetric study. Int J Radiat Oncol Biol Phys 1999;43:79–88.
  • 31. Hochberg FH, Pruitt A. Assumptions in the radiotherapy of glioblastoma. Neurology 1980;30:907–911.
  • 32. Brandsma D, Stalpers L, Taal W, Sminia P, van den Bent MJ. Clinical features, mechanisms, and management of pseudoprogression in malignant gliomas. Lancet Oncol 2008; 9: 453-61
  • 33. Taal W, Brandsma D, de Bruin HG, Bromberg JE, Swaak-Kragten AT, Smitt PA, et al. Incidence of early pseudo-progression in a cohort of malignant glioma patients treated with chemoirradiation with temozolomide. Cancer 2008; 113: 405-10.
  • 34. Haacke EM, Xu Y, Cheng YC, Reichenbach JR. Susceptibility weighted imaging (SWI). Magn Reson Med 2004; 52: 612-8.
  • 35. Rauscher A, Sedlacik J, Barth M, Mentzel HJ, Reichenbach JR. Magnetic susceptibility-weighted MR phase imaging of the human brain. AJNR Am J Neuroradiol 2005; 26: 736-42.
  • 36. Yazol M, Öner A.Y. Beyin Gliomlarında Manyetik Rezonans Görüntüleme Trd Sem 2016; 4: xx
  • 37. Taylor JS, Langston JW, Reddick WE, Kingsley PB, Ogg RJ, Pui MH, et al. Clinical value of proton magnetic resonance spectroscopy for differentiating recurrent or residual brain tumor from delayed cerebral necrosis. Int J Radiat Oncol Biol Phys 1996; 36: 1251-61.
There are 37 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Emine Elif Özkan

Zümrüt Arda Kaymak

İbrahim Çobanbaş

Şehnaz Evrimler

Mustafa Kayan

Publication Date December 25, 2020
Submission Date January 8, 2020
Acceptance Date April 24, 2020
Published in Issue Year 2020 Volume: 27 Issue: 4

Cite

Vancouver Özkan EE, Kaymak ZA, Çobanbaş İ, Evrimler Ş, Kayan M. GBM Olgularında Adjuvan Radyoterapi Sonrası Nüks Paterninin Doz Dağılımı ile İlişkisi: EORTC ve RTOG Kılavuzlarının Değerlendirilmesi. Med J SDU. 2020;27(4):447-54.

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