Journal article
Using Smaller-Than-Standard Radiation Treatment Margins Does Not Change Survival Outcomes in Patients with High-Grade Gliomas
Practical Radiation Oncology, Vol.9(1), pp.16-23
01/01/2019
DOI: 10.1016/j.prro.2018.06.001
PMCID: PMC6487873
PMID: 30195927
Abstract
Purpose: The number of studies that evaluate treatment margins for high grade gliomas (HGG) are limited. We hypothesize that patients with HGG who are treated with a gross tumor volume (GTV) to planning tumor volume (PTV) expansion of <= 1 cm will have progression-free survival (PFS) and overall survival (OS) rates similar to those treated in accordance with standard protocols by the Radiation Therapy Oncology Group or European Organisation for Research and Treatment of Cancer. Furthermore, the PFS and OS of subgroups within the study population will have equivalent survival outcomes with GTVI-to-PTVI margins of 1.0 cm and 0.4 cm.
Methods and materials: Treatment plans and outcomes for patients with pathologically confirmed HGG were analyzed (n= 267). Survival (PFS and OS) was calculated from the time of the first radiation treatment and a chi(2) test or Fisher exact test was used to calculate the associations between margin size and patient characteristics. Survival was estimated using Kaplan-Meier and compared using the log-rank test. All analyses were performed on the univariate level.
ResultsThe median PFS and OS times were 10.6 and 19.1 months, respectively. By disease, the median PFS and OS times were 8.6 and 16.1 months for glioblastoma and 26.7 and 52.5 months for anaplastic glioma. The median follow-up time was 18.3 months. The treatment margin had no effect on outcome and the 1.0 cm GTV1-PTV1 margin subgroup (n = 212) showed median PFS and OS times of 10.7 and 19.1 months, respectively, and the 0.4 cm margin subgroup (n = 55) 10.2 and 19.3 months, respectively. In comparison with the standard treatment with 2 cm to 3 cm margins, there was not a significant difference in outcomes.
Conclusions: Them is no apparent difference in survival when utilizing smaller versus larger margins as defined by the guidelines of the Radiation Therapy Oncology Group and European Organisation for Research and Treatment of Cancer. Although there remains no class I evidence that outcomes after treatment with smaller margins are identical to those after treatment with larger margins, this large series with long-term follow up suggests that a reduction of the margins is safe and further investigation is wananted. (C) 2018 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
Details
- Title: Subtitle
- Using Smaller-Than-Standard Radiation Treatment Margins Does Not Change Survival Outcomes in Patients with High-Grade Gliomas
- Creators
- Kripa Guram - Roy J. and Lucille A. Carver College of MedicineMark Smith - University of Iowa Hospitals and ClinicsTimothy Ginader - University of IowaKellie Bodeker - University of IowaDarrin Pelland - University of Iowa Hospitals and ClinicsEdward Pennington - University of Iowa Hospitals and ClinicsJohn M. Buatti - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Practical Radiation Oncology, Vol.9(1), pp.16-23
- DOI
- 10.1016/j.prro.2018.06.001
- PMID
- 30195927
- PMCID
- PMC6487873
- NLM abbreviation
- Pract Radiat Oncol
- ISSN
- 1879-8500
- eISSN
- 1879-8519
- Publisher
- Elsevier
- Number of pages
- 8
- Grant note
- T35 HL007485 / NHLBI NIH HHS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) P30 CA086862 / NCI NIH HHS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI) P30CA086862 / NATIONAL CANCER INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI) T35HL007485 / NATIONAL HEART, LUNG, AND BLOOD INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
- Language
- English
- Date published
- 01/01/2019
- Academic Unit
- Radiation Oncology; Neurosurgery; Otolaryngology
- Record Identifier
- 9984303910502771
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