NRG brain tumor specialists consensus guidelines for glioblastoma contouring

Abstract

; 312.926.2520. TJK and WRB were responsible for statistical analyses Compliance with ethical standards: Conflict of interest: WRB's reports travel expenses from AAPM, and honoraria from Augmenix Inc. These do not pertain to this work and WRB declares he has no conflict of interest with regard to this study. TJK is on a speaker's bureau for AstraZeneca, has served as a consultant to Varian Medical Systems and was on an advisory board for Abbvie Inc. These do not pertain to this work and TJK declares he has no conflict of interest with regard to this study. CT is on a speaker's bureau for Merck and Varian Medical Systems, advisory board for Novocure. These do not pertain to this work and CT declares she has no conflict of interest with regard to this study. TJCW reports travel expenses from Abbvie, AstraZeneca, and Elekta, serves as a consultant for Abbvie, Merck, Doximity, and Elekta, is on advisory boards for American Cancer Society of New Jersey and AstraZeneca, and Honoria from Elekta and Wolthers Kluwer, and stock options from Doximity. These do not pertain to this work and TJCW declares he has no conflict of interest with regard to this study. MPM has served as a consultant to Agenus, Insys, Remedy, IBA, Varian, Oncoceutics, Astra-Zeneca, Celgene, Tocagen, and is on the DSMB of Monteris, and the Board of Oncoceutics. These do not pertain to this work and MPM declares he has no conflict of interest with regard to this study. KPM has served as a consultant for Via Oncology Pathways; this does not pertain to this work and KPM declares he has no conflict of interest with regard to this study. MMK reports a research grant from EpicentRX, which does not pertain to this work and MMK declares she has no conflict of interest with regard to this study. AAS has participated in an advisory committee, received travel expenses, received honoraria, and received research funding from Blue Earth Diagnostics, as well as travel expenses and honoraria from DAVA Oncology; this does not pertain to this work and AAS declares he has no conflict of interest with regard to this study. SNB, JAB, AJG, SS do not have relevant financial relationships to disclose and declare they have no conflicts of interest with regard to this study.

The Definition and Delineation of the Target Area of Radiotherapy Based on the Recurrence Pattern of Glioblastoma After Temozolomide Chemoradiotherapy

“…The debate is over whether it is necessary to treat all possible tumor microinvasion locations. The theoretical basis for including peritumoral edema is that the edema area may be an infiltrative area ( 6 , 7 ). The theoretical basis for excluding edema is that there is no significant difference in recurrence patterns either with or without edema.…”

Glioma consensus contouring recommendations from a MR-Linac International Consortium Research Group and evaluation of a CT-MRI and MRI-only workflow

“…Furthermore, the ESTRO-ACROP GBM guideline, although providing a detailed expert consensus of target delineation, lacked quantitative analyses of inter-observer contour variability [9]. Finally, Kruser et al recently reported an NRG brain tumor specialist consensus report on GBM contouring, which highlighted several similar findings with respect to limiting the CTV to anatomical boundaries such as the falx, the tentorium cerebelli, and extension of the CTV across the commissural pathways and into the brainstem [8]. However, the NRG study was limited by only a few study cases (4 GBM cases in total) and, therefore, tumor locations.…”

“…The results from our study compare favorably to other glioma delineation studies. For example, the Korean Radiation Oncology Group observed considerable variability amongst 15 radiation oncologists’ contours of GTVs and CTVs (mean kappa 0.58 and 0.65, respectively) in 9 cases of newly diagnosed GBM patients [ 10 ], and the recently reported NRG consensus contouring study by 10 radiation oncologists of 4 GBM cases using a two-dose-level approach reported a kappa statistics range from 0.59 to 0.81 for high and low dose GTVs, and 0.72 to 0.85 for high and low dose CTVs [ 8 ]. In our study, the largest variability was observed in case 4, which illustrated a pineal/thalamic GBM with inferior extension to the superior midbrain and posterior abutment of the tentorium cerebelli.…”

“…Radiotherapy target volumes have differed among various trials group, particularly with respect to the clinical target volume (CTV) as an anatomic margin beyond that of the gross target volume (GTV). Inter-observer variability in target volume delineation of glioblastoma multiforme (GBM) has been evaluated and limited recommendations proposed with respect to target volumes and OARs in previous reports, in some cases in the absence of quantitative analyses [ 8 – 10 ]. With the emergence of MR-guided radiotherapy systems, there is increasing interest in an MRI-only workflow for radiotherapy simulation and planning [ 7 ].…”

Adaptive Radiotherapy for Glioblastoma Multiforme – The Impact on Disease Outcome

“…The target volume definition of GBM varies remarkably at different institutions worldwide as a result of contradictory recommendations. The use of several MRI sequences at different time points, including preoperative MRI with a diffusion-weighted sequence for tractography and functional MRI, thereafter MRI within 48 hours post-surgery and a further pre-RT MRI, has recently become a standard requirement (30).…”