title: Recurrence patterns in patients with high-grade glioma following temozolomide-based chemoradiotherapy.
abstract: There is currently no consensus regarding the optimal radiation volume for high-grade glioma (HGG). The brain volume irradiated is associated with the extent of radiation neurotoxicity. When reducing the treatment volume, the risk of geographic tumor miss should be considered. In such cases, the recurrence patterns and, particularly, the rate of marginal tumor recurrence, are important indices for determining the optimal radiation volume. In the present study, a smaller-target delineation protocol with limited margins was adopted. The postoperative enhancing tumor and resection cavity were defined as gross tumor volume (GTV); 1 and 2 cm were added to the GTV to create clinical target volume (CTV1 and CTV2), which received 60 and 54 Gy, respectively. At a median follow-up of 14 months, 54 HGG patients developed tumor recurrence. The median overall and progression-free survival were 14 and 10.5 months, respectively. A total of 34 patients developed central recurrence, 8 presented with in-field recurrence, 2 developed marginal recurrence, 2 had distant recurrence and 11 patients developed cerebrospinal fluid dissemination, 2 of whom developed central recurrence, with 1 patient simultaneously developing marginal recurrence. Local recurrence (central and in-field) was found to be the main recurrence pattern. As the rate of marginal recurrence was low (<5%), it appears that the smaller irradiated volume in the present study was appropriate. However, clinical trials investigating limited irradiation volume are required to validate our findings.
authors.affiliation: Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Radiation Oncology, Quzhou Central Hospital, Quzhou, Zhejiang 324000, P.R. China.
authors.forename: Xiaofang
authors.initials: X
authors.lastname: Liao
authors.affiliation: Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.
authors.forename: Bicheng
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Quzhou Central Hospital, Quzhou, Zhejiang 324000, P.R. China.
authors.forename: Huijuan
authors.initials: H
authors.lastname: He
authors.affiliation: Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.
authors.forename: Yongjie
authors.initials: Y
authors.lastname: Shui
authors.affiliation: Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.
authors.forename: Wenhong
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Radiology, Quzhou Central Hospital, Quzhou, Zhejiang 324000, P.R. China.
authors.forename: Chaogen
authors.initials: C
authors.lastname: Jiang
authors.affiliation: Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.
authors.forename: Li
authors.initials: L
authors.lastname: Shen
authors.affiliation: Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.
authors.forename: Qichun
authors.initials: Q
authors.lastname: Wei
keywords: chemoradiotherapy; high-grade glioma; irradiated volume; recurrence patterns