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Vienna, Austria

ESTRO 2023

Session Item

CNS
Poster (Digital)
Clinical
Potential role of pre-radiotherapy MRI for target delineation in high-grade gliomas
Camilla Satragno, Italy
PO-1133

Abstract

Potential role of pre-radiotherapy MRI for target delineation in high-grade gliomas
Authors:

camilla satragno1, Alessandra Gonnelli2, Daniela Esposito3, Alessio Ginulla4, Claudio Scaffidi4, Eugenia Cella5, Marco Tagliamento6, N. Giannini7, G. Gadducci7, S. Valenti8, Flavio Giannelli9, Alessandra Fozza10, Elisa Bennicelli11, Pietro Fiaschi12, Silvia Morbelli13, Luca Roccatagliata14, F. Paiar8, Salvina Barra10, Liliana Belgioia15

1University of Genoa, Department of experimental medicine (DIMES), , Genoa, Italy; 2Hospital of Pisa, University of Pisa, Department of Radiotherapy Oncology , Pisa, Italy; 3IRCCS Policlinico San Martino, University of Genoa, Radiation Oncology Unit, Department of Health Sciences (DISSAL) , Genoa, Italy; 4IRCCS Policlinico San Martino, University of Genoa, Radiation Oncology Unit, Department of Health Sciences (DISSAL), Genoa, Italy; 5IRCCS Policlinico San Martino, Medical Oncology 2, Genoa, Italy; 6University of Genoa, Department of Internal Medicine and Medical Specialties (DIMI), Genoa, Italy; 7Hospital of Pisa, University of Pisa, Department of Radiotherapy Oncology, Pisa, Italy; 8Hospital of Pisa, University of Pisa, Department of Radiotherapy Oncology , Pisa, Italy; 9IRCCS Policlinico San Martino, Radiation Oncology Unit,, Genoa, Italy; 10IRCCS Policlinico San Martino, Radiation Oncology Unit, Genoa, Italy; 11IRCCS Policlinico San Martino, Medical Oncology 2 Genoa, Genoa, Italy; 12IRCCS Policlinico San Martino Hospital, University of Genoa, Department of Neurosurgery, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy; 13IRCCS Policlinico San Martino, University of Genoa, Nuclear Medicine Unit, Department of Health Sciences (DISSAL) Genoa, Genoa, Italy; 14IRCCS Policlinico San Martino Hospital, University of Genoa, Department of Neuroradiology, Department of Health Sciences (DISSAL), Genoa, Italy; 15IRCCS Policlinico San Martino, University of Genoa, Radiation Oncology Unit, Department of Health Sciences (DISSAL) , Genoa, Italy

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Purpose or Objective

The aim of the study was to retrospectively confirm that RT planned on pre-RT MRI might allow to spare more normal tissue without decreasing local tumor control, in order to prospectively evaluate the best standard and advanced MRI and metabolic imaging sequences for clinical tumor volume (CTV) adaptation.

Material and Methods

We analyzed a retrospective cohort of patients with HGG treated from 2017 to 2020 to the two Institutes.  All patients had a diagnostic MRI and an immediately post—surgery or pre-RT MRI. Patients were divided into two groups: in group A target volumes were contoured on diagnostic and post-surgery T2/FLAIR MRI, while in group B on pre-RT MRI. We analyzed gross tumor volume (GTV) and CTV volume, and the percentage increase between them. Moreover, we compared the two groups in terms of clinical-pathological characteristics and progression-free survival (PFS) and overall survival (OS).

Results

We analyzed 54 patients (25 group A, 29 group B). The median age of patients was 61 years (IQR 17,75), 93% had an ECOG PS of 0 or 1, 51 were symptomatic at diagnosis. Patients in group B had more frequently MGMT methylation (59 % vs. 28%, p=0.01) while less frequently frontal lobe involvement (60% vs. 24%, p=0.01). The median percentage increase between GTV and CTV was higher in group A than B: 431% (range 62%-7335%) vs 385% (range 53%-3174%), respectively. No significant difference in the pattern of relapse was observed, since >90% of disease recurrences were in-field in both groups. Median PFS and OS of the overall population were 9.5 months (95% CI 7 - 12) and 18.5 months (95% CI 16 - 24), respectively. Patients in group B had a significant better PFS as compared to those in group A (p=0.03), but similar OS. Nevertheless, imbalance in MGMT methylation status between the two groups was a major driver for PFS. Overall, 37 out of 51 patients had improvement in neurological symptoms (p<0.001), with no difference between the two groups (p=0.54).

Conclusion

Our data suggest that CTV adaptation to pre-RT MRI T2/FLAIR may allow to reduce RT volume, without affect symptoms relieving and disease control. Results from the prospective study will help identifying the best adaptation of CTV guided by T2/FLAIR, advanced MRI sequences, in order to optimize efficacy and safety of treatment planning.