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Recurrence distance analysis for clinical target volume optimization in glioblastoma
Patrick L Y Tang1,2,3, Marion Smits1,2,4, Erik D van Werkhoven3
1Brain Tumor Center, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands.
Purpose:
To analyze the pattern of failure in patients with glioblastoma through recurrence distance analysis, and to evaluate the feasibility of reduced and personalized clinical target volume (CTV-)margins.
Methods:
This study included 201 patients with IDH-wildtype glioblastoma who received standard chemoradiation between 2012 and 2022 and subsequently developed tumor recurrence. From these patients, clinical variables, radiotherapy treatment plans, and imaging data were collected. The recurrence distance was defined as the minimum isotropic expansion from the gross tumor volume (GTV) required to encompass 80% of the recurrence volume (RD80). Multiple linear regression modeling with backward elimination was performed to identify variables that correlate with the RD80.
Results:
Median time between the last radiotherapy fraction and progressive disease was 6.8 months (IQR: 4.1-11.8 months). The median RD80 was 1.2 mm (IQR: 0-6.0 mm). For 80% of the patients in our cohort, the RD80 was ≤10.4 mm. In the final multiple linear regression model, the log-transformed GTV volume (β = -0.70, p = 3.9e-7), involvement of the subventricular zone (β = 0.53, p = 0.019) and involvement of the subgranular zone (β = 0.51, p = 0.032) were significantly associated with the log-transformed RD80.
Conclusion:
This work highlights the potential of reduced CTV-margins in patients with glioblastoma, supporting further prospective evaluation.
Insights
This study on glioblastoma recurrence found that smaller gross tumor volume and involvement of specific brain zones correlate with minimal recurrence distance. These findings support exploring reduced clinical target volume margins in glioblastoma treatment.
Area of Science:
- Neuro-oncology
- Radiation Oncology
- Medical Imaging
Background:
- Glioblastoma is an aggressive brain tumor with a high recurrence rate.
- Current treatment strategies involve surgery, radiation, and chemotherapy.
- Optimizing radiation therapy margins is crucial for balancing tumor control and minimizing toxicity.
Purpose of the Study:
- To analyze glioblastoma recurrence patterns using recurrence distance analysis.
- To assess the feasibility of reduced and personalized clinical target volume (CTV) margins.
- To identify factors influencing recurrence patterns in IDH-wildtype glioblastoma patients.
Main Methods:
- Retrospective analysis of 201 IDH-wildtype glioblastoma patients treated with chemoradiation.
- Calculation of recurrence distance (RD80) based on gross tumor volume (GTV) and recurrence volume.
- Multiple linear regression modeling to identify predictors of RD80.
Main Results:
- Median recurrence distance (RD80) was 1.2 mm; 80% of patients had RD80 ≤ 10.4 mm.
- Log-transformed GTV volume, subventricular zone, and subgranular zone involvement significantly correlated with RD80.
- These factors suggest localized recurrence patterns in a significant portion of patients.
Conclusions:
- Reduced CTV margins may be feasible for select glioblastoma patients.
- Recurrence patterns are influenced by tumor volume and location within specific brain zones.
- Further prospective studies are warranted to validate reduced CTV margins in glioblastoma treatment.
