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Evaluating changes in radiation treatment volumes from post-operative to same-day planning MRI in High-grade gliomas.

Publication ,  Journal Article
Champ, CE; Siglin, J; Mishra, MV; Shen, X; Werner-Wasik, M; Andrews, DW; Mayekar, SU; Liu, H; Shi, W
Published in: Radiat Oncol
December 21, 2012

BACKGROUND: Adjuvant radiation therapy (RT) with temozolomide (TMZ) is standard of care for high grade gliomas (HGG) patients. RT is commonly started 3 to 5 weeks after surgery. The deformation of the tumor bed and brain from surgery to RT is poorly studied. This study examined the magnitude of volume change in the postoperative tumor bed and the potential impact of RT planning. METHOD AND MATERIALS: This study includes 24 patients with HGG who underwent craniotomy and adjuvant RT with TMZ at our institution. All patients had immediate postoperative MRI and repeat MRI during the day of RT simulation. Gross tumor volumes (GTV), clinical target volumes (CTV) of initial 46 Gy (CTV1) and boost to 60 Gy (CTV2) were contoured on both sets of MRIs according to RTOG (Radiation Therapy Oncology Group) guidelines. For patients who recurred after RT, the recurrence pattern was evaluated. RESULTS: An average of 17 days elapsed between immediate and delayed MRIs. GTV1 (FLAIR abnormality and tumor bed) decreased significantly on the delayed MRI as compared to immediate post-operative MRI (mean = 30.96cc, p = 0.0005), while GTV2 (contrast-enhanced T1 abnormality and tumor bed) underwent a non-significant increase (mean = 6.82cc, p = 0.07). Such changes lead to significant decrease of CTV1 (mean decrease is 113.9cc, p<0.01), and significant increase of CTV2 (mean increase is 32.5cc, p=0.05). At a median follow-up of 13 months, 16 patients (67%) progressed, recurred, or died, with a progression-free survival time of 13.7 months. Twelve patients failed within all CTVs based on immediate and delayed MRIs, while one patient recurred outside of CTV2 based on immediate post-operative MRI, but within the CTV2 defined on delayed MRI. CONCLUSION: The postoperative tumor bed of HGGs undergoes substantial volumetric changes after surgery. Treatment planning based on delayed MRI significantly reduces the volume of treated brain tissue without local control detriment. The marked reduction of volume treated to 46 Gy based on delayed MRI scan, could result in increased sparing of organs at risk. There may be a small risk of inadequate radiation field design if radiation planning is based on immediate post-operative MRI.

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Published In

Radiat Oncol

DOI

EISSN

1748-717X

Publication Date

December 21, 2012

Volume

7

Start / End Page

220

Location

England

Related Subject Headings

  • Tumor Burden
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Magnetic Resonance Imaging
  • Humans
  • Glioma
  • Disease-Free Survival
  • Brain Neoplasms
  • Aged, 80 and over
 

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Champ, C. E., Siglin, J., Mishra, M. V., Shen, X., Werner-Wasik, M., Andrews, D. W., … Shi, W. (2012). Evaluating changes in radiation treatment volumes from post-operative to same-day planning MRI in High-grade gliomas. Radiat Oncol, 7, 220. https://doi.org/10.1186/1748-717X-7-220
Champ, Colin E., Joshua Siglin, Mark V. Mishra, Xinglei Shen, Maria Werner-Wasik, David W. Andrews, Sonal U. Mayekar, Haisong Liu, and Wenyin Shi. “Evaluating changes in radiation treatment volumes from post-operative to same-day planning MRI in High-grade gliomas.Radiat Oncol 7 (December 21, 2012): 220. https://doi.org/10.1186/1748-717X-7-220.
Champ CE, Siglin J, Mishra MV, Shen X, Werner-Wasik M, Andrews DW, et al. Evaluating changes in radiation treatment volumes from post-operative to same-day planning MRI in High-grade gliomas. Radiat Oncol. 2012 Dec 21;7:220.
Champ, Colin E., et al. “Evaluating changes in radiation treatment volumes from post-operative to same-day planning MRI in High-grade gliomas.Radiat Oncol, vol. 7, Dec. 2012, p. 220. Pubmed, doi:10.1186/1748-717X-7-220.
Champ CE, Siglin J, Mishra MV, Shen X, Werner-Wasik M, Andrews DW, Mayekar SU, Liu H, Shi W. Evaluating changes in radiation treatment volumes from post-operative to same-day planning MRI in High-grade gliomas. Radiat Oncol. 2012 Dec 21;7:220.
Journal cover image

Published In

Radiat Oncol

DOI

EISSN

1748-717X

Publication Date

December 21, 2012

Volume

7

Start / End Page

220

Location

England

Related Subject Headings

  • Tumor Burden
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Magnetic Resonance Imaging
  • Humans
  • Glioma
  • Disease-Free Survival
  • Brain Neoplasms
  • Aged, 80 and over