open access

Vol 23, No 3 (2018)
Original research articles
Published online: 2018-05-01
Submitted: 2016-01-14
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Evaluation of high-grade astrocytoma recurrence patterns after radiotherapy in the era of temozolomide: A single institution experience

Arno Lotar Cordova Jr., Taynná Vernalha Almeida, Cintia Mara Silva, Pedro Argolo Piedade, Cristiane Maria Almeida, Carlos Genesio Bezzera Lima Jr., Carolina Dutra, Rafael Martins Ferreira, Marcelo Neves Linhares, Valeriy Denyak
DOI: 10.1016/j.rpor.2018.02.003
·
Rep Pract Oncol Radiother 2018;23(3):154-160.

open access

Vol 23, No 3 (2018)
Original research articles
Published online: 2018-05-01
Submitted: 2016-01-14

Abstract

Aim

Evaluating the recurrence patterns of high-grade astrocytomas in patients who were treated with radiotherapy (RT) plus temozolomide (TMZ).

Background

The current literature suggests that reducing the margins added to the CTV does not significantly change the risk of recurrence and overall survival; thus, we decided to analyze our data and to examine the possibility of changing the adopted margins.

Materials and methods

From February 2008 till September 2013, 55 patients were treated for high-grade astrocytomas, 20 patients who had been confirmed to have recurrence were selected for the present study. Post-operative MRI was superimposed on the planning CT images in order to correlate the anatomical structures with the treatment targets. Recurrences were defined according to the Response Assessment Criteria for Glioblastoma. The mean margins of the PTVinitial and PTVboost were 1.2[[ce:hsp sp="0.25"/]]cm and 1.4[[ce:hsp sp="0.25"/]]cm, respectively. The analysis of the percentage of the recurrence volume (Volrec) within the 100% isodose surface was based on the following criteria: (I) Central: >95% of the Volrec; (II) In-field: 81–95% of the Volrec; (III) Marginal: 20–80% of the Volrec; and (IV) Outside: <20% of the Volrec.

Results

Of the 20 patients, 13 presented with central recurrences, 3 with in-field recurrences, 2 with marginal recurrences and 2 with outside recurrences. Therefore, the lower Volrec within 100% of the prescribed dose was considered in the classification.

Conclusions

Of the selected patients, 80% had ≥81–95% of the Volrec within 100% of the prescribed dose and predominantly had central or in-field recurrences. These results are comparable with those from the literature.

Abstract

Aim

Evaluating the recurrence patterns of high-grade astrocytomas in patients who were treated with radiotherapy (RT) plus temozolomide (TMZ).

Background

The current literature suggests that reducing the margins added to the CTV does not significantly change the risk of recurrence and overall survival; thus, we decided to analyze our data and to examine the possibility of changing the adopted margins.

Materials and methods

From February 2008 till September 2013, 55 patients were treated for high-grade astrocytomas, 20 patients who had been confirmed to have recurrence were selected for the present study. Post-operative MRI was superimposed on the planning CT images in order to correlate the anatomical structures with the treatment targets. Recurrences were defined according to the Response Assessment Criteria for Glioblastoma. The mean margins of the PTVinitial and PTVboost were 1.2[[ce:hsp sp="0.25"/]]cm and 1.4[[ce:hsp sp="0.25"/]]cm, respectively. The analysis of the percentage of the recurrence volume (Volrec) within the 100% isodose surface was based on the following criteria: (I) Central: >95% of the Volrec; (II) In-field: 81–95% of the Volrec; (III) Marginal: 20–80% of the Volrec; and (IV) Outside: <20% of the Volrec.

Results

Of the 20 patients, 13 presented with central recurrences, 3 with in-field recurrences, 2 with marginal recurrences and 2 with outside recurrences. Therefore, the lower Volrec within 100% of the prescribed dose was considered in the classification.

Conclusions

Of the selected patients, 80% had ≥81–95% of the Volrec within 100% of the prescribed dose and predominantly had central or in-field recurrences. These results are comparable with those from the literature.

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Keywords

High-grade astrocytoma; Brain radiotherapy; Temozolomide; Recurrence patterns; Planning target volume

About this article
Title

Evaluation of high-grade astrocytoma recurrence patterns after radiotherapy in the era of temozolomide: A single institution experience

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 23, No 3 (2018)

Pages

154-160

Published online

2018-05-01

DOI

10.1016/j.rpor.2018.02.003

Bibliographic record

Rep Pract Oncol Radiother 2018;23(3):154-160.

Keywords

High-grade astrocytoma
Brain radiotherapy
Temozolomide
Recurrence patterns
Planning target volume

Authors

Arno Lotar Cordova Jr.
Taynná Vernalha Almeida
Cintia Mara Silva
Pedro Argolo Piedade
Cristiane Maria Almeida
Carlos Genesio Bezzera Lima Jr.
Carolina Dutra
Rafael Martins Ferreira
Marcelo Neves Linhares
Valeriy Denyak

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