Feasibility and outcomes of hypofractionated simultaneous integrated boost-intensity modulated radiotherapy for malignant gliomas: A preliminary report

Jihye Cha, Chang Ok Suh, Kwangwoo Park, Jong Hee Chang, Kyu Sung Lee, Se Hoon Kim, Jee Suk Chang, Joo Ho Kim, Yang Gun Suh, Jun Won Kim, Jaeho Cho

Research output: Contribution to journalArticle

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Abstract

Purpose: The aim of this study was to assess the feasibility and efficacy of hypofractionated simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) using three-layered planning target volumes (PTV) for malignant gliomas. Materials and Methods: We conducted a retrospective analysis of 12 patients (WHO grade IV-10; III-2) postoperatively treated with SIB-IMRT with concurrent temozolomide. Three-layered PTVs were contoured based on gadolinium-enhanced magnetic resonance imaging as follows; high risk PTV (H-PTV) as the area of surgical bed including residual gross tumor with a 0.5 cm margin; low risk PTV (L-PTV) as the area surrounding the high risk PTV with 1.5 cm margin; moderate risk PTV (M-PTV) as a line at one-third the distance from high risk PTV to low risk PTV. Total dose to high risk PTV was 70 Gy in 8 and 62.5 Gy in 4 patients. Results: The median follow-up time was 52 months in surviving patients. The 2- and 5-year overall survival (OS) rates were 66.6% and 47.6%, respectively. The 2- and 5-year progression-free survival (PFS) rates were 57.1% and 45.7%, respectively. The median OS and PFS were 48 and 31 months, respectively. Six patients (50%) progressed: in-field only in one, out-field or disseminated in 4, and both in one patient. All patients completed planned treatments without a toxicity-related gap. Asymptomatic radiation necrosis was observed in 4 patients at post-radiotherapy 9-31 months. Conclusion: An escalated dose of hypofractionated SIB-IMRT using three-layered PTVs can be safely performed in patients with malignant glioma, and might contribute to better tumor control and survival.

Original languageEnglish
Pages (from-to)70-77
Number of pages8
JournalYonsei medical journal
Volume55
Issue number1
DOIs
Publication statusPublished - 2014 Jan 1

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Intensity-Modulated Radiotherapy
Glioma
temozolomide
Disease-Free Survival
Survival Rate
Survival
Gadolinium
Residual Neoplasm
Necrosis
Radiotherapy
Magnetic Resonance Imaging
Radiation

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Cha, Jihye ; Suh, Chang Ok ; Park, Kwangwoo ; Chang, Jong Hee ; Lee, Kyu Sung ; Kim, Se Hoon ; Chang, Jee Suk ; Kim, Joo Ho ; Suh, Yang Gun ; Kim, Jun Won ; Cho, Jaeho. / Feasibility and outcomes of hypofractionated simultaneous integrated boost-intensity modulated radiotherapy for malignant gliomas : A preliminary report. In: Yonsei medical journal. 2014 ; Vol. 55, No. 1. pp. 70-77.
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abstract = "Purpose: The aim of this study was to assess the feasibility and efficacy of hypofractionated simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) using three-layered planning target volumes (PTV) for malignant gliomas. Materials and Methods: We conducted a retrospective analysis of 12 patients (WHO grade IV-10; III-2) postoperatively treated with SIB-IMRT with concurrent temozolomide. Three-layered PTVs were contoured based on gadolinium-enhanced magnetic resonance imaging as follows; high risk PTV (H-PTV) as the area of surgical bed including residual gross tumor with a 0.5 cm margin; low risk PTV (L-PTV) as the area surrounding the high risk PTV with 1.5 cm margin; moderate risk PTV (M-PTV) as a line at one-third the distance from high risk PTV to low risk PTV. Total dose to high risk PTV was 70 Gy in 8 and 62.5 Gy in 4 patients. Results: The median follow-up time was 52 months in surviving patients. The 2- and 5-year overall survival (OS) rates were 66.6{\%} and 47.6{\%}, respectively. The 2- and 5-year progression-free survival (PFS) rates were 57.1{\%} and 45.7{\%}, respectively. The median OS and PFS were 48 and 31 months, respectively. Six patients (50{\%}) progressed: in-field only in one, out-field or disseminated in 4, and both in one patient. All patients completed planned treatments without a toxicity-related gap. Asymptomatic radiation necrosis was observed in 4 patients at post-radiotherapy 9-31 months. Conclusion: An escalated dose of hypofractionated SIB-IMRT using three-layered PTVs can be safely performed in patients with malignant glioma, and might contribute to better tumor control and survival.",
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Feasibility and outcomes of hypofractionated simultaneous integrated boost-intensity modulated radiotherapy for malignant gliomas : A preliminary report. / Cha, Jihye; Suh, Chang Ok; Park, Kwangwoo; Chang, Jong Hee; Lee, Kyu Sung; Kim, Se Hoon; Chang, Jee Suk; Kim, Joo Ho; Suh, Yang Gun; Kim, Jun Won; Cho, Jaeho.

In: Yonsei medical journal, Vol. 55, No. 1, 01.01.2014, p. 70-77.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Feasibility and outcomes of hypofractionated simultaneous integrated boost-intensity modulated radiotherapy for malignant gliomas

T2 - A preliminary report

AU - Cha, Jihye

AU - Suh, Chang Ok

AU - Park, Kwangwoo

AU - Chang, Jong Hee

AU - Lee, Kyu Sung

AU - Kim, Se Hoon

AU - Chang, Jee Suk

AU - Kim, Joo Ho

AU - Suh, Yang Gun

AU - Kim, Jun Won

AU - Cho, Jaeho

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Purpose: The aim of this study was to assess the feasibility and efficacy of hypofractionated simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) using three-layered planning target volumes (PTV) for malignant gliomas. Materials and Methods: We conducted a retrospective analysis of 12 patients (WHO grade IV-10; III-2) postoperatively treated with SIB-IMRT with concurrent temozolomide. Three-layered PTVs were contoured based on gadolinium-enhanced magnetic resonance imaging as follows; high risk PTV (H-PTV) as the area of surgical bed including residual gross tumor with a 0.5 cm margin; low risk PTV (L-PTV) as the area surrounding the high risk PTV with 1.5 cm margin; moderate risk PTV (M-PTV) as a line at one-third the distance from high risk PTV to low risk PTV. Total dose to high risk PTV was 70 Gy in 8 and 62.5 Gy in 4 patients. Results: The median follow-up time was 52 months in surviving patients. The 2- and 5-year overall survival (OS) rates were 66.6% and 47.6%, respectively. The 2- and 5-year progression-free survival (PFS) rates were 57.1% and 45.7%, respectively. The median OS and PFS were 48 and 31 months, respectively. Six patients (50%) progressed: in-field only in one, out-field or disseminated in 4, and both in one patient. All patients completed planned treatments without a toxicity-related gap. Asymptomatic radiation necrosis was observed in 4 patients at post-radiotherapy 9-31 months. Conclusion: An escalated dose of hypofractionated SIB-IMRT using three-layered PTVs can be safely performed in patients with malignant glioma, and might contribute to better tumor control and survival.

AB - Purpose: The aim of this study was to assess the feasibility and efficacy of hypofractionated simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) using three-layered planning target volumes (PTV) for malignant gliomas. Materials and Methods: We conducted a retrospective analysis of 12 patients (WHO grade IV-10; III-2) postoperatively treated with SIB-IMRT with concurrent temozolomide. Three-layered PTVs were contoured based on gadolinium-enhanced magnetic resonance imaging as follows; high risk PTV (H-PTV) as the area of surgical bed including residual gross tumor with a 0.5 cm margin; low risk PTV (L-PTV) as the area surrounding the high risk PTV with 1.5 cm margin; moderate risk PTV (M-PTV) as a line at one-third the distance from high risk PTV to low risk PTV. Total dose to high risk PTV was 70 Gy in 8 and 62.5 Gy in 4 patients. Results: The median follow-up time was 52 months in surviving patients. The 2- and 5-year overall survival (OS) rates were 66.6% and 47.6%, respectively. The 2- and 5-year progression-free survival (PFS) rates were 57.1% and 45.7%, respectively. The median OS and PFS were 48 and 31 months, respectively. Six patients (50%) progressed: in-field only in one, out-field or disseminated in 4, and both in one patient. All patients completed planned treatments without a toxicity-related gap. Asymptomatic radiation necrosis was observed in 4 patients at post-radiotherapy 9-31 months. Conclusion: An escalated dose of hypofractionated SIB-IMRT using three-layered PTVs can be safely performed in patients with malignant glioma, and might contribute to better tumor control and survival.

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