A Prospective Study of Conventionally Fractionated Dose Constraints for Reirradiation of Primary Brain Tumors in Adults

被引：3

作者：

McGovern, Susan L. ^{[1
]}

Luo, Dershan ^{[1
]}

Johnson, Jason ^{[2
]}

Nguyen, Kham ^{[1
]}

Li, Jing ^{[1
]}

McAleer, Mary Frances ^{[1
]}

Yeboa, Debra ^{[1
]}

Grosshans, David R. ^{[1
]}

Ghia, Amol J. ^{[1
]}

Chung, Caroline ^{[1
]}

Bishop, Andrew J. ^{[1
]}

Song, Juhee ^{[3
]}

Thall, Peter F. ^{[3
]}

Brown, Paul D. ^{[4
]}

Mahajan, Anita ^{[4
]}

机构：

[1] Univ Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USA

[2] Univ Texas MD Anderson Canc Ctr, Dept Diagnost Imaging, Houston, TX USA

[3] Univ Texas MD Anderson Canc Ctr, Dept Biostat, Houston, TX USA

[4] Mayo Clin, Dept Radiat Oncol, Rochester, MN USA

来源：

PRACTICAL RADIATION ONCOLOGY | 2023年 / 13卷 / 03期

基金：

美国国家卫生研究院;

关键词：

RECURRENT GLIOBLASTOMA; BEVACIZUMAB;

D O I：

10.1016/j.prro.2022.12.006

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Purpose: Dose constraints for reirradiation of recurrent primary brain tumors are not well-established. This study was conducted to prospectively evaluate composite dose constraints for conventionally fractionated brain reirradiation. Methods and Materials: A single-institution, prospective study of adults with previously irradiated, recurrent brain tumors was per-formed. For 95% of patients, electronic dosimetry records from the first course of radiation (RT1) were obtained and deformed onto the simulation computed tomography for the second course of radiation (RT2). Conventionally fractionated treatment plans for RT2 were developed that met protocol-assigned dose constraints for RT2 alone and the composite dose of RT1 + RT2. Prospective composite dose constraints were based on histology, interval since RT1, and concurrent bevacizumab. Patients were followed with magnetic reso-nance imaging including spectroscopy and perfusion studies. Primary endpoint was the rate of symptomatic brain necrosis at 6 months after RT2. Results: Patients were enrolled from March 2017 to May 2018; 20 were evaluable. Eighteen had glioma, 1 had atypical choroid plexus papilloma, and 1 had hemangiopericytoma. Nineteen patients were treated with volumetric modulated arc therapy, and one was treated with protons. Median RT1 dose was 57 Gy (range, 50-60 Gy). Median RT1-RT2 interval was 49 months (range, 9-141 months). Median RT2 dose was 42.4 Gy (range, 36-60 Gy). Median planning target volume was 186 cc (range, 8-468 cc). Nineteen of 20 patients (95%) were free of grade 3+ central nervous system necrosis. One patient had grade 3+ necrosis 2 months after RT2; the patient recovered fully and lived another 18 months until dying of disease progression. Median overall survival from RT2 start for all patients was 13.3 months (95% credible interval, 6.3-20.7); for patients with glioblastoma, 11.5 months (95% credible interval, 6.1-20.1). Conclusions: Brain reirradiation can be safely performed with conventionally fractionated regimens tailored to previous dose distribu-tions. The prospective composite dose constraints described here are a starting point for future studies of conventionally fractionated reirradiation.(c) 2023 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

引用

页码：231 / 238

页数：8