J Korean Med Sci.  2013 Aug;28(8):1233-1237. 10.3346/jkms.2013.28.8.1233.

Interfractional Variation of Radiation Target and Adaptive Radiotherapy for Totally Resected Glioblastoma

• Kim TG
• Lim DH

• KMID: 1793031
• DOI: http://doi.org/10.3346/jkms.2013.28.8.1233

Abstract

This study aimed to evaluate the effects of volume adapted re-planning for radiotherapy (RT) after gross total resection (GTR) for glioblastoma. Nineteen patients with glioblastoma who underwent GTR and postoperative RT were analyzed. The volumes of the surgical cavity on computed tomography (CT) obtained one day after GTR (CT0), the first RT simulation CT (sim-CT1), and the second simulation CT for the boost RT plan (sim-CT2) were compared. The boost RT plan was based on the surgical cavity observed on the sim-CT2 (boost RTP2) and was compared with that based on the surgical cavity observed on the sim-CT1 (boost RTP1). The volume reduction ratios were 14.4%-51.3% (median, 29.0%) between CT0 and sim-CT1 and -7.9%-71.9% (median, 34.9%) between sim-CT1 and sim-CT2 (P < 0.001). The normal brain volumes in boost RTP1 were significantly reduced in boost RTP2, especially at high dose levels. Target volume in sim-CT2 which was not covered with the boost RTP1, developed in five cases (26.3%). The surgical cavity volume was reduced following surgery in patients with glioblastoma who underwent GTR. The application of volume-adapted re-planning during RT could decrease the irradiated volume of normal brain and prevent a target miss for boost RT.

Keyword

Glioblastomas; Surgery; Brain; Radiotherapy, Image-Guided

MeSH Terms

Aged
Aged, 80 and over
Brain Neoplasms/*radiotherapy/surgery
Female
Glioblastoma/*radiotherapy/surgery
Humans
Male
Middle Aged
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Treatment schedule and definitions of parameters: GTV1 and GTV2 were surgical defects on sim-CT1 and sim-CT2. Sim-CT, simulation CT; GTV, gross tumor volume; CTV, clinical target volume.

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  Fig. 2 The schematic presentations of each 95% isodose lines, GTV and CTV in sim-CT1 and sim-CT2; CTV2 may not be fully covered with 95% isodose line of boost RTP1 (C). RTP, radiation treatment planning.

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  Fig. 3 The changes in surgical defect after surgery: The white circles show the changes of volumes of surgical defect. (A) CT image of one day after surgery. (B) CT image of first simulation for postoperative radiotherapy. (C) CT image of second simulation for boost radiotherapy.

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  Fig. 4 Boxplots of dose-volume relationship of normal brain in two boost radiation treatment plannings (RTP). The irradiated volume of normal brain decreased significantly according to Vx% from boost RTP1 to boost RTP2 at all dose level.

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