Limited margins using modern radiotherapy techniques does not increase marginal failure rate of glioblastoma

Anna K. Paulsson, Kevin P. McMullen, Ann M. Peiffer, William H. Hinson, William T. Kearns, Annette J. Johnson, Glenn J. Lesser, Thomas L. Ellis, Stephen B. Tatter, Waldemar Debinski, Edward G. Shaw, Michael D. Chan

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: We investigate the patterns of failure in the treatment of glioblastoma (GBM) based on clinical target volume (CTV) margin size, dose delivered to the site of initial failure, and the use of temozolomide and intensity-modulated radiotherapy (IMRT). Methods: Between August 2000 and May 2010, 161 patients with GBM were treated with radiotherapy with or without concurrent temozolomide. Patients were treated with CTV expansions that ranged from 5 to 20mm using a shrinking field technique. Patterns of failure and time to progression and overall survival were compared based on CTV margin, use of temozolomide, and use of IMRT. Kaplan Meier analysis was used to estimate survival times, and w2 test was used for comparison of cohorts. Results: For patients treated with 5-, 10-, and 15- to 20-mm CTV, 79%, 77%, and 86% experienced failures in the 60 Gy volume, respectively. Forty-eight percent, 55%, and 66% of patients with 5-, 10-, and 15- to 20-mm CTV experienced failures in the 46 Gy volume, respectively. There was no statistical difference between patients treated with 5-, 10-, 15- to 20-mm margins with regard to 60 Gy failure (P = 0.76), 46 Gy failure (P = 0.51), or marginal failure (P = 0.73). Eighty percent of patients receiving temozolomide experienced failures in the 60 Gy volume. There was no increased likelihood of marginal failures in patients receiving IMRT (P = 0.97). Conclusions: Modern treatment techniques including use of concurrent temozolmide, limited CTV margin size, and IMRT have not greatly changed the patterns of failure of GBM.

Original languageEnglish (US)
Pages (from-to)177-181
Number of pages5
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume37
Issue number2
DOIs
StatePublished - 2014
Externally publishedYes

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temozolomide
Glioblastoma
Radiotherapy
Intensity-Modulated Radiotherapy
Survival
Kaplan-Meier Estimate
Treatment Failure

Keywords

  • Clinical target volume
  • Glioblastoma
  • Patterns of failure

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Medicine(all)

Cite this

Limited margins using modern radiotherapy techniques does not increase marginal failure rate of glioblastoma. / Paulsson, Anna K.; McMullen, Kevin P.; Peiffer, Ann M.; Hinson, William H.; Kearns, William T.; Johnson, Annette J.; Lesser, Glenn J.; Ellis, Thomas L.; Tatter, Stephen B.; Debinski, Waldemar; Shaw, Edward G.; Chan, Michael D.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 37, No. 2, 2014, p. 177-181.

Research output: Contribution to journalArticle

Paulsson, AK, McMullen, KP, Peiffer, AM, Hinson, WH, Kearns, WT, Johnson, AJ, Lesser, GJ, Ellis, TL, Tatter, SB, Debinski, W, Shaw, EG & Chan, MD 2014, 'Limited margins using modern radiotherapy techniques does not increase marginal failure rate of glioblastoma', American Journal of Clinical Oncology: Cancer Clinical Trials, vol. 37, no. 2, pp. 177-181. https://doi.org/10.1097/COC.0b013e318271ae03
Paulsson, Anna K. ; McMullen, Kevin P. ; Peiffer, Ann M. ; Hinson, William H. ; Kearns, William T. ; Johnson, Annette J. ; Lesser, Glenn J. ; Ellis, Thomas L. ; Tatter, Stephen B. ; Debinski, Waldemar ; Shaw, Edward G. ; Chan, Michael D. / Limited margins using modern radiotherapy techniques does not increase marginal failure rate of glioblastoma. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2014 ; Vol. 37, No. 2. pp. 177-181.
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abstract = "Objective: We investigate the patterns of failure in the treatment of glioblastoma (GBM) based on clinical target volume (CTV) margin size, dose delivered to the site of initial failure, and the use of temozolomide and intensity-modulated radiotherapy (IMRT). Methods: Between August 2000 and May 2010, 161 patients with GBM were treated with radiotherapy with or without concurrent temozolomide. Patients were treated with CTV expansions that ranged from 5 to 20mm using a shrinking field technique. Patterns of failure and time to progression and overall survival were compared based on CTV margin, use of temozolomide, and use of IMRT. Kaplan Meier analysis was used to estimate survival times, and w2 test was used for comparison of cohorts. Results: For patients treated with 5-, 10-, and 15- to 20-mm CTV, 79{\%}, 77{\%}, and 86{\%} experienced failures in the 60 Gy volume, respectively. Forty-eight percent, 55{\%}, and 66{\%} of patients with 5-, 10-, and 15- to 20-mm CTV experienced failures in the 46 Gy volume, respectively. There was no statistical difference between patients treated with 5-, 10-, 15- to 20-mm margins with regard to 60 Gy failure (P = 0.76), 46 Gy failure (P = 0.51), or marginal failure (P = 0.73). Eighty percent of patients receiving temozolomide experienced failures in the 60 Gy volume. There was no increased likelihood of marginal failures in patients receiving IMRT (P = 0.97). Conclusions: Modern treatment techniques including use of concurrent temozolmide, limited CTV margin size, and IMRT have not greatly changed the patterns of failure of GBM.",
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T1 - Limited margins using modern radiotherapy techniques does not increase marginal failure rate of glioblastoma

AU - Paulsson, Anna K.

AU - McMullen, Kevin P.

AU - Peiffer, Ann M.

AU - Hinson, William H.

AU - Kearns, William T.

AU - Johnson, Annette J.

AU - Lesser, Glenn J.

AU - Ellis, Thomas L.

AU - Tatter, Stephen B.

AU - Debinski, Waldemar

AU - Shaw, Edward G.

AU - Chan, Michael D.

PY - 2014

Y1 - 2014

N2 - Objective: We investigate the patterns of failure in the treatment of glioblastoma (GBM) based on clinical target volume (CTV) margin size, dose delivered to the site of initial failure, and the use of temozolomide and intensity-modulated radiotherapy (IMRT). Methods: Between August 2000 and May 2010, 161 patients with GBM were treated with radiotherapy with or without concurrent temozolomide. Patients were treated with CTV expansions that ranged from 5 to 20mm using a shrinking field technique. Patterns of failure and time to progression and overall survival were compared based on CTV margin, use of temozolomide, and use of IMRT. Kaplan Meier analysis was used to estimate survival times, and w2 test was used for comparison of cohorts. Results: For patients treated with 5-, 10-, and 15- to 20-mm CTV, 79%, 77%, and 86% experienced failures in the 60 Gy volume, respectively. Forty-eight percent, 55%, and 66% of patients with 5-, 10-, and 15- to 20-mm CTV experienced failures in the 46 Gy volume, respectively. There was no statistical difference between patients treated with 5-, 10-, 15- to 20-mm margins with regard to 60 Gy failure (P = 0.76), 46 Gy failure (P = 0.51), or marginal failure (P = 0.73). Eighty percent of patients receiving temozolomide experienced failures in the 60 Gy volume. There was no increased likelihood of marginal failures in patients receiving IMRT (P = 0.97). Conclusions: Modern treatment techniques including use of concurrent temozolmide, limited CTV margin size, and IMRT have not greatly changed the patterns of failure of GBM.

AB - Objective: We investigate the patterns of failure in the treatment of glioblastoma (GBM) based on clinical target volume (CTV) margin size, dose delivered to the site of initial failure, and the use of temozolomide and intensity-modulated radiotherapy (IMRT). Methods: Between August 2000 and May 2010, 161 patients with GBM were treated with radiotherapy with or without concurrent temozolomide. Patients were treated with CTV expansions that ranged from 5 to 20mm using a shrinking field technique. Patterns of failure and time to progression and overall survival were compared based on CTV margin, use of temozolomide, and use of IMRT. Kaplan Meier analysis was used to estimate survival times, and w2 test was used for comparison of cohorts. Results: For patients treated with 5-, 10-, and 15- to 20-mm CTV, 79%, 77%, and 86% experienced failures in the 60 Gy volume, respectively. Forty-eight percent, 55%, and 66% of patients with 5-, 10-, and 15- to 20-mm CTV experienced failures in the 46 Gy volume, respectively. There was no statistical difference between patients treated with 5-, 10-, 15- to 20-mm margins with regard to 60 Gy failure (P = 0.76), 46 Gy failure (P = 0.51), or marginal failure (P = 0.73). Eighty percent of patients receiving temozolomide experienced failures in the 60 Gy volume. There was no increased likelihood of marginal failures in patients receiving IMRT (P = 0.97). Conclusions: Modern treatment techniques including use of concurrent temozolmide, limited CTV margin size, and IMRT have not greatly changed the patterns of failure of GBM.

KW - Clinical target volume

KW - Glioblastoma

KW - Patterns of failure

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