Recurrence risk factors within the CTV-PTV margins in high-grade gliomas after alternative radiotherapy regimens

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A pilot study of 44 patients with verified high-grade gliomas identified risk factors for a recurrence within the CTV-PTV margins. Multivariate analysis showed that an individual dose level in terms of the linear-quadratic (LQ) model (< 60 Gy ≥), the ratio of the mean dose to the prescribed dose (mean/PD), the level of V100 (75≤V100ptv>75), age (< 55 years ≥), Karnofsky index before radiotherapy (< 70% ≥) were significant parameters. In the high-dose radiotherapy (HD-RT) group (high doses ≥60 Gy according to the LQ model with α/β=8.3), the first progression occurs much later, the median survival is 1.01 year (95.0% CI: 0.82—1.19). With a lower dose, a local recurrence in terms of duration is diagnosed twice earlier (median survival, 0.5 year). As compared with the HD-RT group, the LD-RT one showed a 6.5-fold survival decrease in terms of a local recurrence (95.0% CI: 2.51—16.78). Univariate analysis also indicated that the LQ level was significant (p=0.002). If after dosimetric planning the mean/PD ratio is ≥0.97, the subsequent survival rate according to the criterion of a local recurrence is 7.1 times higher (95.0% CI: 0.04—0.45). If the prescribed dose is 3 Gy, the mean dose should be more than 2.91 Gy. The mean/PD ratio was also significant, as shown by univariate analysis (p=0.007), since the individual LQ level and mean/PD are to be recognized as independent parameters that affect the development of a recurrence within the CTV-PTV margins.

Keywords:

high-grade gliomas

linear-quadratic model

mean dose

Authors:

Datsenko P.V.

Herzen Moscow Oncology Research Institute, Moscow, Russia, 125284

Boldyreva V.V.

Herzen Moscow Oncology Research Institute, Moscow, Russia, 125284

Gerasimov V.A.

Herzen Moscow Oncology Research Institute, Moscow, Russia, 125284

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