Background
Methods
Patient selection
Imaging data
Treatment
SVZ delineation and dosimetry data collection
Patterns of recurrence
Statistical analysis
Results
Patient characteristics
Characteristic |
n = 43 | V20Gy to bSVZ ≤84% (n = 32) | V20Gy to bSVZ >84% (n = 8) |
p
|
---|---|---|---|---|
Age at surgery (years) (median, range) | 59 (25–85) | 60 (30–85) | 64.5 (45–76) | 0.710 |
Gender | 0.222 | |||
Male | 28 (65.1%) | 19 (59.4%) | 7 (87.5%) | |
Female | 15 (34.9%) | 13 (40.6%) | 1 (12.5%) | |
ECOG performance status at diagnosis | 0.080 | |||
0–1 | 33 (76.7%) | 28 (87.5%) | 3 (37.5%) | |
2–4 | 10 (23.3%) | 4 (12.5%) | 5 (62.5%) | |
Tumor side | 0.406 | |||
Right | 29 (67.4%) | 22 (68.8%) | 7 (87.5%) | |
Left | 13 (30.2%) | 10 (31.3%) | 1 (12.5%) | |
Both | 1 (2.4%) | 0 | 0 | |
Tumor location | 0.014 | |||
Frontal | 12 (27.9%) | 5 (15.6%) | 6 (75%) | |
Temporal | 18 (41.9%) | 16 (50%) | 1 (12.5%) | |
Parietal | 10 (23.3%) | 9 (28.1%) | 1 (12.5%) | |
Occipital | 2 (4.7%) | 2 (6.3%) | 0 | |
Thalamic | 1 (2.3%) | 0 | 0 | |
Multilobar lesion | 0.689 | |||
No | 29 (67.4%) | 20 (62.5%) | 6 (75%) | |
Yes | 14 (32.6%) | 12 (37.5%) | 2 (25%) | |
Tumor SVZ contact | 0.424 | |||
Yes | 26 (63.4%) | 21 (67.7%) | 4 (50%) | |
No | 15 (36.6%) | 10 (32.3%) | 4 (50%) | |
Missing | 2 | 1 | 0 | |
Minimal distance to SVZ (mm) | 0.366 | |||
Median (range) | 0 (0–27.8) | 0 (0–27.8) | 5.3 (0–24.6) | |
Missing | 2 | 1 | 0 | |
T1 post-gadolinium volume (cm3) | 0.585 | |||
Median (range) | 40.8 (4.4–151.9) | 40.5 (4.4–94.5) | 46.6 (6.5–151.9) | |
Missing | 3 | 1 | ||
FLAIR volume (cm3) | 0.290 | |||
Median (range) | 151.4 (24.8–342.6) | 115.3 (24.8–269) | 194.1 (69.8–342.6) | |
MGMT status | 0.413 | |||
Methylated | 14 (35%) | 9 (31%) | 4 (50%) | |
Unmethylated | 26 (65%) | 20 (69%) | 4 (50%) | |
Unknown | 3 | 3 | 0 | |
Extent of resection | 0.430 | |||
GTR/NTR | 19 (44.2%) | 13 (40.6%) | 5 (62.5%) | |
STR | 24 (55.8%) | 19 (59.4%) | 3 (37.5%) | |
Number of cycles of adjuvant temozolomide (median, range) | 6 (1–15) | 3 (1–15) | 5 (2–9) | 0.510 |
SVZ without temporal horn (TH-) (n = 40) | SVZ with temporal horn (TH+) (n = 40) |
p
| |
---|---|---|---|
Volume (cm3) | |||
iSVZ | 5 (3.4–11) | 7.8 (4.9–15.5) | <0.001 |
cSVZ | 5.5 (3.4–9.6) | 7.8 (5.6–15.1) | <0.001 |
bSVZ | 10.6 (6.8–20.6) | 15 (11.8–30.6) | <0.001 |
Mean dose (Gy) | |||
iSVZ | 51.3 (17.9–61.4) | 45.7 (22.9–61.5) | 0.298 |
cSVZ | 15.4 (1.4–48.7) | 13.7 (1.3–41.5) | <0.001 |
bSVZ | 35 (10.8–51.8) | 32.9 (14–46.4) | 0.830 |
V10Gy (%) | |||
iSVZ | 100 (41.3–100) | 100 (55.4–100) | 0.637 |
cSVZ | 83.4 (0–100) | 73.6 (0–100) | 0.074 |
bSVZ | 90.9 (26.6–100) | 86.5 (36.5–100) | 0.264 |
V20 Gy (%) | |||
iSVZ | 96.8 (16.9–100) | 83.7 (29.8–100) | 0.256 |
cSVZ | 11.6 (0–100) | 8.2 (0–92.1) | <0.001 |
bSVZ | 52.6 (8.4–100) | 52.3 (15–96.1) | 0.444 |
V30 Gy (%) | |||
iSVZ | 87.6 (11.2–100) | 72.1 (20.8–100) | 0.392 |
cSVZ | 0 (0–83.8) | 0 (0–66.6) | <0.001 |
bSVZ | 48.5 (5.6–91.3) | 46.3 (10.4–76.5) | 0.861 |
V40 Gy (%) | |||
iSVZ | 79.7 (8.5–100) | 67 (17.5–100) | 0.357 |
cSVZ | 0 (0–75.6) | 0 (0–62.2) | <0.001 |
bSVZ | 43.5 (4.2–83.8) | 40.8 (8.8–72.7) | 0.883 |
V50 Gy (%) | |||
iSVZ | 69.1 (5.5–100) | 63.8 (14.2–100) | 0.451 |
cSVZ | 0 (0–71.4) | 0 (0–56.4) | <0.001 |
bSVZ | 37 (2.7–74.3) | 34.9 (7.1–66.3) | 0.798 |
V60 Gy (%) | |||
iSVZ | 28.7 (0–99.1) | 28.2 (0–99.7) | 0.687 |
cSVZ | (0–53.9) | 0 (0–41.8) | 0.317 |
bSVZ | 13.8 (0–60.6) | 14.2 (0–49.9) | 0.677 |
Univariate analysis
Prognostic factors | Median TTP (months) |
p value | Median OS (months) |
p value |
---|---|---|---|---|
Age | ||||
< 60 years | 5.2 | 0.651 | 24.7 | 0.914 |
≥ 60 years | 6.4 | 14.4 | ||
Gender | ||||
Male | 4.8 | 0.406 | 20.5 | 0.603 |
Female | 9.1 | 26.2 | ||
ECOG performans status | ||||
0–1 | 5.3 | 0.366 | 24.7 | 0.465 |
2–4 | 6.7 | 14.6 | ||
Multilobar lesion | ||||
No | 5.6 | 0.826 | 20.7 | 0.896 |
Yes | 6.4 | 22.7 | ||
Tumor SVZ contact | ||||
Yes | 4.6 |
0.002
| 18.7 |
0.014
|
No | 12.9 | 41.7 | ||
MGMT status | ||||
Methylated | 5.3 | 0.245 | 24.7 | 0.281 |
Unmethylated | 6.4 | 20.5 | ||
Extent of resection | ||||
GTR/NTR | 5.6 | 0.669 | 25.1 | 0.598 |
STR | 6.4 | 18.7 |
Surgical parameters
SVZ dosimetric parameters
Without temporal horn (TH-) | With temporal horn (TH+) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
n = | Med TTP (mo) |
p
| Med OS (mo) |
p
|
n = | Med TTP (mo) |
p
| Med OS (mo) |
p
| |
Dmean (40 Gy) | ||||||||||
iSVZ | ||||||||||
≤ 40 Gy | 15 | 5.2 | 0.283 | 18.9 | 0.549 | 10 | 5.2 | 0.727 | 20.3 | 0.659 |
> 40 Gy | 25 | 6.6 | 24.7 | 30 | 5.6 | 24.7 | ||||
bSVZ | ||||||||||
≤ 40 Gy | 30 | 4.6 |
0.023
| 20.7 | 0.198 | 34 | 5.3 | 0.399 | 24.7 | 0.963 |
> 40 Gy | 10 | 9.4 | 22.7 | 6 | 9.1 | 11.7 | ||||
Dmean (43 Gy) | ||||||||||
iSVZ | ||||||||||
≤ 43 Gy | 17 | 5.3 | 0.529 | 20.3 | 0.392 | 14 | 12.1 | 0.072 | 26.2 | 0.087 |
> 43 Gy | 23 | 6.4 | 25.1 | 26 | 4.8 | 20.5 | ||||
bSVZ | ||||||||||
≤ 43 Gy | 33 | 5.3 | 0.073 | 22.7 | 0.397 | - | - | - | - | - |
> 43 Gy | 7 | 9.1 | 34.2 | - | - | - | ||||
V20 Gy | ||||||||||
iSVZ | ||||||||||
≤ 84% | 15 | 5.3 | 0.528 | 20.7 | 0.709 | 20 | - | - | - | - |
> 84% | 25 | 6.4 | 24.7 | 20 | - | - | ||||
bSVZ | ||||||||||
≤ 84% | 32 | 5.2 |
0.017
| 22.7 | 0.19 | 39 | - | - | - | - |
> 84% | 8 | 17.7 | 20.3 | 1 | - | - |
Multivariate analysis
HR | 95% CI |
p value | |
---|---|---|---|
V20 Gy to bSVZ | |||
> 84% | 1.00 | ||
≤ 84% | 2.67 | [1.01; 7.03] |
0.047
|
Tumor SVZ contact | |||
No | 1.00 | ||
Yes | 3.07 | [1.27; 7.39] |
0.012
|
Patterns of recurrence
Discussion
Studies |
n = | Cut-off mean dose to SVZ | TTP (months) HR (IC95%) |
p
| OS (months) HR (IC95%) |
p
|
---|---|---|---|---|---|---|
Evers 2010 [34] | 55 | bSVZ ≥ 43Gy vs < 43Gy | 15 vs 7.2 | 0.028*
| NK | NA |
bSVZ dose (continuous) ma
| 0.73 (0.57–0.95) | 0.019*
| NK | NA | ||
Slotman 2011 [35] | 40 | bSVZ ≥ 43Gy vs < 43Gy | 13.2 vs 13.1 | 0.740 | 18.6 vs 20.1 | 0.930 |
Lee 2012 [36] | 173 | iSVZ > 59.4Gy vs ≤ 59.4Gy | 12.6 vs 9.9 | 0.042*
| 25.8 vs 19.2 | 0.173 |
iSVZ > 59.4Gy ma
| 0.45 (0.25–0.82) | 0.009*
| 0.65 (0.35–1.21) | 0.177 | ||
Gupta 2012 [37] | 40 | iSVZ > 59.9Gy vs ≤ 59.9Gy | 10 vs 11 | 0.920 | 17 vs 15 | 0.950 |
iSVZ dose (continuous) ma
| 0.91 (0.80–1.03) | 0.116 | 0.87 (0.77–0.98) | 0.025*
| ||
cSVZ > 57.9Gy vs ≤ 57.9Gy | NR vs 10 | 0.02*
| NR vs 14 | 0.05 | ||
cSVZ > 57.9Gy ma
| 0.96 (0.91–1.30) | 0.797 | 0.95 (0.72–1.26) | 0.736 | ||
Chen 2013 [38] | 116 | iSVZ ≥ 40Gy vs < 40Gy | 0.82 (0.51–1.34) | 0.434 | 0.93 (0.57–1.50) | 0.754 |
GTR subgroup:
| ||||||
iSVZ ≥ 40Gy vs < 40Gy
|
15.1 vs 10.3
|
0.023
*
|
17.5 vs 15.6
|
0.027
*
| ||
iSVZ ≥ 40Gy
ma
|
0.39 (0.17–0.90)
|
0.028
*
|
0.39 (0.17–0.90)
|
0.027
*
| ||
Elicin 2014 [39] | 60 | cSVZ ≥ 59.2Gy vs < 59.2Gy | 7.1 vs 10.4 | 0.009*
| NK | NA |
cSVZ ≥ 59.2Gy ma
| 1.72 (0.80–3.53) | 0.161 | ||||
Adeberg 2016 [40] | 54 | iSVZ ≥ 40Gy vs < 40Gy | 8.5 vs 5.2 | 0.013*
| 21.3 vs 18.0 | 0.19 |
iSVZ ≥ 40Gy ma
| 0.52 (0.26–1.03) | 0.06 | ||||
cSVZ ≥ 30Gy vs < 30Gy | 10.1 vs 6.9 | 0.025*
| 21.6 vs 21.2 | 0.29 | ||
cSVZ ≥ 30Gy ma
| 0.45 (0.20–0.98) | 0.04*
| ||||
Khalifa 2017 | 43 |
SVZ without temporal horn:
| ||||
bSVZ > 40Gy vs ≤ 40Gy | 9.4 vs 4.6 | 0.023*
| 22.7 vs 20.7 | 0.198 | ||
V20Gy to bSVZ > 84% vs ≤84% | 17.7 vs 5.2 | 0.017*
| 20.3 vs 22.7 | 0.19 | ||
V20Gy to bSVZ ≤84% ma
| 2.67 (1.01–7.03) | 0.047*
|