Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.
Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada.
Technol Cancer Res Treat. 2022 Jan-Dec;21:15330338221109650. doi: 10.1177/15330338221109650.
To quantitatively compare the recurrence patterns of glioblastoma (isocitrate dehydrogenase-wild type) versus grade 4 isocitrate dehydrogenase-mutant astrocytoma (wild type isocitrate dehydrogenase and mutant isocitrate dehydrogenase, respectively) following primary chemoradiation. A retrospective matched cohort of 22 wild type isocitrate dehydrogenase and 22 mutant isocitrate dehydrogenase patients were matched by sex, extent of resection, and corpus callosum involvement. The recurrent gross tumor volume was compared to the original gross tumor volume and clinical target volume contours from radiotherapy planning. Failure patterns were quantified by the incidence and volume of the recurrent gross tumor volume outside the gross tumor volume and clinical target volume, and positional differences of the recurrent gross tumor volume centroid from the gross tumor volume and clinical target volume. The gross tumor volume was smaller for wild type isocitrate dehydrogenase patients compared to the mutant isocitrate dehydrogenase cohort (mean ± SD: 46.5 ± 26.0 cm vs 72.2 ± 45.4 cm, = .026). The recurrent gross tumor volume was 10.7 ± 26.9 cm and 46.9 ± 55.0 cm smaller than the gross tumor volume for the same groups ( = .018). The recurrent gross tumor volume extended outside the gross tumor volume in 22 (100%) and 15 (68%) (= .009) of wild type isocitrate dehydrogenase and mutant isocitrate dehydrogenase patients, respectively; however, the volume of recurrent gross tumor volume outside the gross tumor volume was not significantly different (12.4 ± 16.1 cm vs 8.4 ± 14.2 cm, = .443). The recurrent gross tumor volume centroid was within 5.7 mm of the closest gross tumor volume edge for 21 (95%) and 22 (100%) of wild type isocitrate dehydrogenase and mutant isocitrate dehydrogenase patients, respectively. The recurrent gross tumor volume extended beyond the gross tumor volume less often in mutant isocitrate dehydrogenase patients possibly implying a differential response to chemoradiotherapy and suggesting isocitrate dehydrogenase status might be used to personalize radiotherapy. The results require validation in prospective randomized trials.
为了定量比较原发性放化疗后胶质母细胞瘤（异柠檬酸脱氢酶野生型）与 4 级异柠檬酸脱氢酶突变型星形细胞瘤（野生型异柠檬酸脱氢酶和突变型异柠檬酸脱氢酶）的复发模式。对 22 例野生型异柠檬酸脱氢酶和 22 例突变型异柠檬酸脱氢酶患者进行了回顾性匹配队列研究，匹配因素为性别、切除范围和胼胝体受累。将复发性大体肿瘤体积与放疗计划的原始大体肿瘤体积和临床靶区体积轮廓进行比较。通过复发大体肿瘤体积超出大体肿瘤体积和临床靶区体积的发生率和体积以及复发大体肿瘤体积质心与大体肿瘤体积和临床靶区体积的位置差异来量化失败模式。与突变型异柠檬酸脱氢酶组相比，野生型异柠檬酸脱氢酶患者的大体肿瘤体积较小（平均值±标准差：46.5±26.0 cm 与 72.2±45.4 cm， = .026）。复发的大体肿瘤体积比同一组的大体肿瘤体积小 10.7±26.9 cm 和 46.9±55.0 cm（ = .018）。在 22 例（100%）和 15 例（68%）野生型异柠檬酸脱氢酶和突变型异柠檬酸脱氢酶患者中，复发的大体肿瘤体积延伸至大体肿瘤体积之外（ = .009）；然而，大体肿瘤体积之外的复发大体肿瘤体积体积没有显著差异（12.4±16.1 cm 与 8.4±14.2 cm， = .443）。在 21 例（95%）和 22 例（100%）野生型异柠檬酸脱氢酶和突变型异柠檬酸脱氢酶患者中，复发大体肿瘤体积质心与最近的大体肿瘤体积边缘的距离均在 5.7 mm 以内。突变型异柠檬酸脱氢酶患者的复发大体肿瘤体积较少延伸至大体肿瘤体积之外，这可能表明对放化疗有不同的反应，并表明异柠檬酸脱氢酶状态可能用于个体化放疗。这些结果需要在前瞻性随机试验中验证。
