Huang Yong, Ding Haixia, Luo Min, Li Zhiqiang, Li Sirui, Xie Conghua, Zhong Yahua
Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China.
Hubei Cancer Clinical Study Center, Wuhan University, Wuhan, China.
Front Oncol. 2022 Oct 19;12:931436. doi: 10.3389/fonc.2022.931436. eCollection 2022.
No consensus has currently been reached regarding the optimal radiation volume for radiotherapy of glioblastoma. Here, we have proposed a new delineation approach to delineating clinical target volume based on the relationship between the growth patterns of glioblastoma and neural pathways. Its safety and efficacy were evaluated in a phase II clinical trial.
A total of 69 patients with histologically confirmed glioblastoma were enrolled. All patients underwent tumor resection, followed by focal radiotherapy and concomitant temozolomide (TMZ), and then received six cycles of adjuvant TMZ. The gross tumor volume (GTV) was defined as the surgical resection cavity plus any residual enhancing tumor, on contrast enhanced T1-weighted MRI. The clinical target volume (CTV) was delineated through our new approach.
The median recurrence-free survival (RFS) and overall survival (OS) were 11.4 months and 18.2 months, which were better than the previous reports. Relapse was found in 47 patients, of whom 41 patients (87.2%) failed in central, two patients (4.3%) failed in field, and four patients (8.5%) failed in distance. No marginal recurrence was found. Our regimen showed a trend of lower rates of marginal recurrence, and the brain volume of high-dose radiation fields in our regimen was similar to that of EORTC (p = 0.257).
We have proposed a novel method for the delineation of clinical target volume by referencing the nerve fiber bundles for radiotherapy of glioblastoma. The results of the present phase II clinical trial suggest that this approach may be feasible and effective.
目前关于胶质母细胞瘤放射治疗的最佳照射体积尚未达成共识。在此，我们基于胶质母细胞瘤的生长模式与神经通路之间的关系，提出了一种新的临床靶区勾画方法。在一项II期临床试验中评估了其安全性和有效性。
共纳入69例经组织学确诊的胶质母细胞瘤患者。所有患者均接受肿瘤切除，随后进行局部放疗并同步替莫唑胺（TMZ）治疗，然后接受六个周期的辅助TMZ治疗。在对比增强T1加权MRI上，将大体肿瘤体积（GTV）定义为手术切除腔加上任何残留的强化肿瘤。通过我们的新方法勾画临床靶区（CTV）。
中位无复发生存期（RFS）和总生存期（OS）分别为11.4个月和18.2个月，优于先前报道。47例患者出现复发，其中41例（87.2%）在中心部位复发，2例（4.3%）在靶区内复发，4例（8.5%）在远处复发。未发现边缘复发。我们的方案显示边缘复发率有降低趋势，且我们方案中高剂量照射野的脑体积与欧洲癌症研究与治疗组织（EORTC）的相似（p = 0.257）。
我们提出了一种通过参考神经纤维束来勾画胶质母细胞瘤放射治疗临床靶区的新方法。本II期临床试验结果表明该方法可能可行且有效。
