Abstract
BackgroundTo assess the impact of volumetric-modulated arc therapy (VMAT) compared with 3D-conformal radiotherapy (3DCRT) in patients with newly diagnosed high grade glioma in terms of toxicity, progression free survival (PFS) and overall survival (OS).MethodsFrom March 2004 to October 2014, 341 patients underwent surgery followed by concomitant and adjuvant chemo-radiotherapy. From 2003 to 2010, 167 patients were treated using 3DCRT; starting from 2011, 174 patients underwent VMAT. The quantitative evaluation of the treatment plans was performed by means of standard dose volume histogram analysis. Response was recorded using the Response Assessment in Neuro-Oncology (RANO) criteria and toxicities graded according to Common Terminology Criteria for Adverse Event version 4.0.ResultsBoth techniques achieved an adequate dose conformity to the target. The median follow up time was 1.3 years; at the last observation 76 patients (23.4 %) were alive and 249 (76.6 %) dead (16 patients were lot to follow-up). For patients who underwent 3DCRT, the median PFS was 0.99 ± 0.07 years (CI95: 0.9–1.1 years); the 1 and 3 years PFS were, 49.6 ± 4 and 19.1 ± 3.1 %. This shall be compared, respectively, to 1.29 ± 0.13 years (CI95: 1.01–1.5 years), 60.8 ± 3.8, and 29.7 ± 4.6 % for patients who underwent VMAT (p = 0.02). The median OS for 3DCRT patients was 1.21 ± 0.09 years (CI95:1.03–1.3 years); 1 and 5 year OS was, 63.3 ± 3.8 and 21.5 ± 3.3 %. The corresponding results for 3DRCT patients were 1.56 ± 0.09 years (CI95:1.37–1.74 years), 73.4 ± 3.5, 30 ± 4.6 % respectively (p < 0.01). In both groups, prognostic factors conditioning PFS and OS were age, gender, KPS, histology and extent of resection (EOR).ConclusionsVMAT resulted superior to 3DCRT in terms of dosimetric findings and clinical results.
Highlights
To assess the impact of volumetric-modulated arc therapy (VMAT) compared with 3D-conformal radiotherapy (3DCRT) in patients with newly diagnosed high grade glioma in terms of toxicity, progression free survival (PFS) and overall survival (OS)
Patients and treatments From March 2004 to October 2014, 341 consecutive patients referred to our institution for high grade glioma (HGG) were included in this analysis; 124 (36 %) were female and 217 (64 %) male with a median age of 59 years; 251 (73.6 %) patients had a diagnosis of GB, and 90 (26.4 %) patients World health organization (WHO) grade III glioma
Incomplete resection or biopsy was performed in the case of tumors involving eloquent areas. 3DCRT was performed from 2003 to 2010 in 167 patients (49 %) and VMAT from 2011 to 2014 in 174 patients (51 %)
Summary
To assess the impact of volumetric-modulated arc therapy (VMAT) compared with 3D-conformal radiotherapy (3DCRT) in patients with newly diagnosed high grade glioma in terms of toxicity, progression free survival (PFS) and overall survival (OS). In WHO grade III glioma the outcome in terms of progression free survival (PFS) and overall survival (OS) is better compared to GB patients but the incidence of local recurrence is still considerable, above all in the case of astrocytic tumors subtypes [2,3,4,5]. Compared to 3D-conformal radiation therapy (3DCRT), IMRT provides similar results in terms of target coverage, but it results in a better dose conformity to the target with a better sparing of the organs at risk (OARs). The variation of the three dynamic parameters is used to cover the planning target volume (PTV) with clinically acceptable dose and to spare organs at risk and normal tissues, reducing the treatment time
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