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Radiation Oncology

, 9:20

Clinical Radiation Oncology


BackgroundTo dosimetrically evaluate the effect of reduced margin radiotherapy on hippocampal dose for glioblastoma multiforme GBM patients.

MethodsGBM patients enrolled on the Radiation Therapy Oncology Group RTOG 0825 trial at our institution were identified. Standard RTOG 0825 expansions were 2 cm + 3-5 mm from the gross tumor volume GTV to the clinical tumor volume CTV and from the CTV to the planning tumor volume PTV, respectively. These same patients also had reduced margin tumor volumes generated with 8 mm GTV to CTV + 3 mm CTV to PTV expansions. Individual plans were created for both standard and reduced margin structures. The dose-volume histograms were statistically compared with a paired, two-tailed Student’s t-test with a significance level of p < 0.05.

ResultsA total of 16 patients were enrolled on RTOG 0825. The reduced margins resulted in statistically significant reductions in hippocampal dose at all evaluated endpoints. The hippocampal Dmax was reduced from a mean of 61.4 Gy to 56.1 Gy 8.7%, D40% was reduced from 49.9 Gy to 36.5 Gy 26.9%, D60% was reduced from 32.7 Gy to 18.7 Gy 42.9% and the D80% was reduced from 27.3 Gy to 15.3 Gy 44%.

ConclusionsThe use of reduced margin PTV expansions in the treatment of GBM patients results in significant reductions in hippocampal dose. Though the exact clinical benefit of this reduction is currently unclear, this study does provide support for a future prospective trial evaluating the neurocognitive benefits of reduced margin tumor volumes in the treatment of GBM patients.

KeywordsGlioblastoma multiforme GBM Hippocampus Electronic supplementary materialThe online version of this article doi:10.1186-1748-717X-9-20 contains supplementary material, which is available to authorized users.

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Autor: Arif N Ali - Tomi Ogunleye - Claire W Hardy - Hui-Kuo Shu - Walter J Curran - Ian R Crocker


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