Aims: The EORTC-NCI study investigating the addition of temozolomide trial to standard radiation therapy has demonstrated improved duration of survival in patients with Glioblastoma multiforme (GBM). With longer survi...Aims: The EORTC-NCI study investigating the addition of temozolomide trial to standard radiation therapy has demonstrated improved duration of survival in patients with Glioblastoma multiforme (GBM). With longer survival duration, there is the potential for latent RT morbidity, not previously seen in historical patients. This study evaluates the potential dosimetric advantages of utilising IMRT over 3D-conformal RT in such patients. Methods: 10 consecutive patients with GBM formally screened for a clinical study over a two-month period were planned and treated with IMRT utilising daily on-board imaging (OBI). The EORTC protocol dosimetric criteria and constraints were used in target delineation and planning. For each patient, a 3DCRT plan was also produced. Endpoints for dosimetric evaluation analysed related to tumour dose: mean PTV60 dose (mPTV60Dose), Conformity Index (CI);and normal tissue dose: mean normal brain dose (mBrainDose) and V40 Brain (Brainv40). IGRT endpoints were the median isocentre shifts required in 3 axes measured in one direction. The variation between the IMRT and 3DCRT dosimetric endpoints was examined using Wilcoxon analysis. Results: The 10 patients had tumours located in temporal (3), parietal (3), occipital (2) and callosal (2) regions. The median PTV and normal brain volumes were 308.1 cm3 and 1077.5 cm3 respectively. The IMRT dosimetry was significantly improved in all endpoints specifically CI (p = 0.002), mPTV60Dose (p = 0.004), mBrainDose (p = 0.002) and Brainv40 (p = 0.019). OBI directed isocentre measurements in the patient group were available for 230 treatments. The median shifts (and 95% C.I.s) were 0.1 cm vertical (0.1 - 0.2), 0.1 cm longitudinal (0.1 - 0.2) and 0.2 cm lateral (0.2 - 0.2). At a minimum follow-up of 2 years’ post diagnosis, the median survival of the group is 18.0 months (95% CI: 13.4 - 22.6 months). Conclusion: IMRT for GBM produces significant dosimetric advantages in relation to planning target volume and normal tissue dose compared with 3D conformal plans. The data also confirm the accuracy of IMRT technique for CNS with IGRT delivery utilising OBI demonstrating minimal deviation from planned to treated isocentre.展开更多
Cognitive deficits related to tumour or treatment are estimated to be present in the majority of patients diagnosed with a primary brain tumour, with a large variation based on tumour site, extent, and grade, as well ...Cognitive deficits related to tumour or treatment are estimated to be present in the majority of patients diagnosed with a primary brain tumour, with a large variation based on tumour site, extent, and grade, as well as nature of intervention. These deficits have a significant impact on patient’s quality of life and functional status. The improved patient survival duration in recent years has increased the need to detect, understand and intervene on these cognitive deficits, and optimise patient pathways for treatment. This article reviews the nature of deficits arising in patients with primary brain tumour, and the association of the deficits with neuroanatomical site of tumour. The approach to interventions through adaptation and remediation is outlined, with aim of improving function, promoting generalization of outcomes and optimizing any neuroplasticity that may arise. The evidence for pharmacological therapies and cognitive rehabilitation is presented, and a framework for implementation is provided.展开更多
文摘Aims: The EORTC-NCI study investigating the addition of temozolomide trial to standard radiation therapy has demonstrated improved duration of survival in patients with Glioblastoma multiforme (GBM). With longer survival duration, there is the potential for latent RT morbidity, not previously seen in historical patients. This study evaluates the potential dosimetric advantages of utilising IMRT over 3D-conformal RT in such patients. Methods: 10 consecutive patients with GBM formally screened for a clinical study over a two-month period were planned and treated with IMRT utilising daily on-board imaging (OBI). The EORTC protocol dosimetric criteria and constraints were used in target delineation and planning. For each patient, a 3DCRT plan was also produced. Endpoints for dosimetric evaluation analysed related to tumour dose: mean PTV60 dose (mPTV60Dose), Conformity Index (CI);and normal tissue dose: mean normal brain dose (mBrainDose) and V40 Brain (Brainv40). IGRT endpoints were the median isocentre shifts required in 3 axes measured in one direction. The variation between the IMRT and 3DCRT dosimetric endpoints was examined using Wilcoxon analysis. Results: The 10 patients had tumours located in temporal (3), parietal (3), occipital (2) and callosal (2) regions. The median PTV and normal brain volumes were 308.1 cm3 and 1077.5 cm3 respectively. The IMRT dosimetry was significantly improved in all endpoints specifically CI (p = 0.002), mPTV60Dose (p = 0.004), mBrainDose (p = 0.002) and Brainv40 (p = 0.019). OBI directed isocentre measurements in the patient group were available for 230 treatments. The median shifts (and 95% C.I.s) were 0.1 cm vertical (0.1 - 0.2), 0.1 cm longitudinal (0.1 - 0.2) and 0.2 cm lateral (0.2 - 0.2). At a minimum follow-up of 2 years’ post diagnosis, the median survival of the group is 18.0 months (95% CI: 13.4 - 22.6 months). Conclusion: IMRT for GBM produces significant dosimetric advantages in relation to planning target volume and normal tissue dose compared with 3D conformal plans. The data also confirm the accuracy of IMRT technique for CNS with IGRT delivery utilising OBI demonstrating minimal deviation from planned to treated isocentre.
文摘Cognitive deficits related to tumour or treatment are estimated to be present in the majority of patients diagnosed with a primary brain tumour, with a large variation based on tumour site, extent, and grade, as well as nature of intervention. These deficits have a significant impact on patient’s quality of life and functional status. The improved patient survival duration in recent years has increased the need to detect, understand and intervene on these cognitive deficits, and optimise patient pathways for treatment. This article reviews the nature of deficits arising in patients with primary brain tumour, and the association of the deficits with neuroanatomical site of tumour. The approach to interventions through adaptation and remediation is outlined, with aim of improving function, promoting generalization of outcomes and optimizing any neuroplasticity that may arise. The evidence for pharmacological therapies and cognitive rehabilitation is presented, and a framework for implementation is provided.
