Maximilian Niyazi1, Michael Brada2, Anthony J Chalmers3, Stephanie E Combs4, Sara C Erridge5, Alba Fiorentino6, Anca L Grosu7, Frank J Lagerwaard8, Giuseppe Minniti9, René-Olivier Mirimanoff10, Umberto Ricardi11, Susan C Short12, Damien C Weber13, Claus Belka1. 1. Department of Radiation Oncology, University of Munich, München, Germany. 2. Department of Molecular and Clinical Cancer Medicine, Liverpool, UK. 3. Institute of Cancer Sciences, University of Glasgow, UK. 4. Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Institut für Innovative Radiotherapy (iRT), Germany. 5. Edinburgh Centre for Neuro-Oncology, University of Edinburgh, Western General Hospital, UK. 6. Department of Radiation Oncology, Sacro Cuore Hospital, Negrar-Verona, Italy. 7. Department of Radiation Oncology, University Medical Center Freiburg, Germany. 8. Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands. 9. Unit of Radiation Oncology, Sant'Andrea Hospital, University of Rome Sapienza, Italy. 10. Radiation Oncology, Faculty of Biology and Medicine, University of Lausanne, Switzerland. 11. Department of Oncology, University of Turin, Italy. 12. Leeds Institute of Cancer and Pathology, St James's University Hospital, UK. 13. Center for Proton Therapy, Paul Scherrer Institute, Switzerland; University of Zürich, Switzerland.
Abstract
BACKGROUND AND PURPOSE: Target delineation in glioblastoma (GBM) varies substantially between different institutions and several consensus statements are available. This guideline aims to develop a joint European consensus on the delineation of the clinical target volume in patients with a glioblastoma (GBM). MATERIAL AND METHODS: A literature search was conducted in PubMed that evaluated adults with GBM. Both MeSH terms and text words were used and the following search strategy was applied: ("Glioblastoma/radiotherapy" [MeSH] OR "glioblastoma" OR "malignant glioma" OR high-grade glioma) AND ((delineation) OR (target volume) OR (CTV) OR (PTV) OR (margin) OR (recurrence pattern) OR (contouring) OR (organs at risk)). In parallel, abstracts from ESTRO and ASTRO 2010-2015 were analysed and separately reviewed. The ACROP committee identified 14 European experts in close interaction with the ESTRO clinical committee who discussed and analysed the body of evidence concerning GBM target delineation. RESULTS: Several key issues were identified and are discussed including (i) pre-treatment steps and immobilization, (ii) target delineation and the use of standard and novel imaging techniques, and (iii) technical aspects of treatment including planning techniques, and fractionation. Based on the EORTC recommendation focusing on the resection cavity and residual enhancing regions on T1-sequences with the addition of a 20mm margin, special situations are presented with corresponding potential adaptations depending on the specific clinical situation. CONCLUSIONS: Currently, based on the EORTC consensus, a single clinical target volume definition based on postoperative T1/T2 FLAIR abnormalities is recommended, using isotropic margins without the need to cone down. A PTV margin based on the individual mask system and IGRT procedures available is advised, usually of the order of 3-5mm.
BACKGROUND AND PURPOSE: Target delineation in glioblastoma (GBM) varies substantially between different institutions and several consensus statements are available. This guideline aims to develop a joint European consensus on the delineation of the clinical target volume in patients with a glioblastoma (GBM). MATERIAL AND METHODS: A literature search was conducted in PubMed that evaluated adults with GBM. Both MeSH terms and text words were used and the following search strategy was applied: ("Glioblastoma/radiotherapy" [MeSH] OR "glioblastoma" OR "malignant glioma" OR high-grade glioma) AND ((delineation) OR (target volume) OR (CTV) OR (PTV) OR (margin) OR (recurrence pattern) OR (contouring) OR (organs at risk)). In parallel, abstracts from ESTRO and ASTRO 2010-2015 were analysed and separately reviewed. The ACROP committee identified 14 European experts in close interaction with the ESTRO clinical committee who discussed and analysed the body of evidence concerning GBM target delineation. RESULTS: Several key issues were identified and are discussed including (i) pre-treatment steps and immobilization, (ii) target delineation and the use of standard and novel imaging techniques, and (iii) technical aspects of treatment including planning techniques, and fractionation. Based on the EORTC recommendation focusing on the resection cavity and residual enhancing regions on T1-sequences with the addition of a 20mm margin, special situations are presented with corresponding potential adaptations depending on the specific clinical situation. CONCLUSIONS: Currently, based on the EORTC consensus, a single clinical target volume definition based on postoperative T1/T2 FLAIR abnormalities is recommended, using isotropic margins without the need to cone down. A PTV margin based on the individual mask system and IGRT procedures available is advised, usually of the order of 3-5mm.
Authors: Patrick Y Wen; Michael Weller; Eudocia Quant Lee; Brian M Alexander; Jill S Barnholtz-Sloan; Floris P Barthel; Tracy T Batchelor; Ranjit S Bindra; Susan M Chang; E Antonio Chiocca; Timothy F Cloughesy; John F DeGroot; Evanthia Galanis; Mark R Gilbert; Monika E Hegi; Craig Horbinski; Raymond Y Huang; Andrew B Lassman; Emilie Le Rhun; Michael Lim; Minesh P Mehta; Ingo K Mellinghoff; Giuseppe Minniti; David Nathanson; Michael Platten; Matthias Preusser; Patrick Roth; Marc Sanson; David Schiff; Susan C Short; Martin J B Taphoorn; Joerg-Christian Tonn; Jonathan Tsang; Roel G W Verhaak; Andreas von Deimling; Wolfgang Wick; Gelareh Zadeh; David A Reardon; Kenneth D Aldape; Martin J van den Bent Journal: Neuro Oncol Date: 2020-08-17 Impact factor: 12.300
Authors: Tim J Kruser; Walter R Bosch; Shahed N Badiyan; Joseph A Bovi; Amol J Ghia; Michelle M Kim; Abhishek A Solanki; Sean Sachdev; Christina Tsien; Tony J C Wang; Minesh P Mehta; Kevin P McMullen Journal: J Neurooncol Date: 2019-03-19 Impact factor: 4.130
Authors: Michael Lundemann; Per Munck Af Rosenschöld; Aida Muhic; Vibeke A Larsen; Hans S Poulsen; Svend-Aage Engelholm; Flemming L Andersen; Andreas Kjær; Henrik B W Larsson; Ian Law; Adam E Hansen Journal: Eur J Nucl Med Mol Imaging Date: 2018-10-02 Impact factor: 9.236