MSOR5 Presentation Time: 5:20 PM

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2024-10-25 DOI:10.1016/j.brachy.2024.08.039

Christopher P. Cifarelli MD, PhD, MMM , Kevin Petrecca MD , Henning Kahl MD , Oliver Ganslandt MD, PhD , Tamer Abdelrhman MD, PhD , Stephanie Combs MD , Gustavo Sarria MD , Frank A. Giordano MD

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引用次数: 0

Abstract

Purpose

While the use of 5-ALA has been used to increase the extent of surgical resection in glioblastoma (GBM), its potential to act as a radiosensitizer has not been widely studied in the CNS. Whereas typical external beam radiotherapy (EBRT) treatments occur weeks after surgery and 5-ALA administration, intraoperative radiotherapy (IORT) delivers radiation while protoporphyrin IX is still present in residual tumor. This current study examines the potential for radiation necrosis (RN) development following IORT and subsequent fractionated radiotherapy.

Methods

Interim data from the INTRAGO II study for newly diagnosed GBM (NCT02685605) were analyzed for the incidence of radiation necrosis (RN) based on 5-ALA use, IORT treatment vs SOC control (60Gy EBRT), and extent of resection. Statistical analysis was performed via univariate (ANOVA), multivariate (Cox regression), and K-M estimations with significance of p<0.05.

Results

234 patients were enrolled in INTRAGO II between 2016 and 2022. Of these, 185 (79%) had a surgical resection performed with the use of 5-ALA tumor fluorescence visualization. Following surgical resection with 5-ALA, 94 (51%) received IORT (30Gy to the margin) and an additional 60Gy EBRT (ARM A). Imaging confirmed RN occurred in 11 (12%) of ARM A patients who had 5-ALA assisted resection, compared to 3 (3.3%) of ARM B patients who received only 60Gy EBRT. In the 49 patients not receiving 5-ALA, the imaging confirmed the RN rate in ARM A patients was 21% (5/24) compared to 12% in ARM B (3/25). The median time to development of RN was 236 days post-IORT and 158 days post completion of EBRT. ANOVA demonstrated a significantly (p=0.025) higher rate of RN in ARM A patients overall, but not with the addition of 5-ALA. Cox regression analysis confirmed that only significant predictor of RN on multivariate analysis was IORT plus EBRT (p=0.033) and KM estimations-Log Rank test of RN incidence were greater in Arm A/IORT patients than SOC/Arm B (p=0.029).

Conclusions

While patients receiving IORT at the time of surgical resection had a higher rate of RN after SOC 60Gy EBRT, the use of 5-ALA in conjunction with surgical resection did not increase RN incidence. Further analysis will need to consider local PFS rates and the impact of 5-ALA use with IORT.

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MSOR5 演讲时间：下午 5:20

目的虽然 5-ALA 已被用于增加胶质母细胞瘤（GBM）的手术切除范围，但其在中枢神经系统中作为放射增敏剂的潜力尚未得到广泛研究。典型的体外放射治疗（EBRT）是在手术和给药 5-ALA 数周后进行的，而术中放射治疗（IORT）则是在原卟啉 IX 仍存在于残留肿瘤中时进行放射治疗。方法分析了 INTRAGO II 新诊断 GBM 研究（NCT02685605）的中期数据，根据 5-ALA 的使用、IORT 治疗与 SOC 对照（60Gy EBRT）以及切除范围，分析辐射坏死（RN）的发生率。统计分析通过单变量（方差分析）、多变量（Cox 回归）和 K-M 估计进行，显著性为 p<0.05。其中 185 人（79%）在 5-ALA 肿瘤荧光显像下进行了手术切除。使用 5-ALA 进行手术切除后，94 人（51%）接受了 IORT（30Gy 至边缘）和额外的 60Gy EBRT（ARM A）。在接受了 5-ALA 辅助切除术的 ARM A 患者中，有 11 人（12%）经影像学证实出现了 RN，而在仅接受 60Gy EBRT 的 ARM B 患者中，有 3 人（3.3%）经影像学证实出现了 RN。在未接受 5-ALA 的 49 例患者中，ARM A 患者的成像证实 RN 发生率为 21% (5/24)，而 ARM B 患者为 12% (3/25)。RN发生的中位时间为IORT后236天，EBRT结束后158天。方差分析显示，ARM A 患者的 RN 发生率总体上明显较高（P=0.025），但在添加 5-ALA 后并不明显。Cox回归分析证实，多变量分析中唯一显著的RN预测因子是IORT加EBRT（p=0.033），Arm/IORT患者的RN发生率的KM估计-对数秩检验大于SOC/Arm B（p=0.029）。进一步的分析需要考虑局部PFS率以及在IORT同时使用5-ALA的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Brachytherapy 医学-核医学

CiteScore

3.40

自引率

21.10%

发文量

119

审稿时长

9.1 weeks

期刊介绍： Brachytherapy is an international and multidisciplinary journal that publishes original peer-reviewed articles and selected reviews on the techniques and clinical applications of interstitial and intracavitary radiation in the management of cancers. Laboratory and experimental research relevant to clinical practice is also included. Related disciplines include medical physics, medical oncology, and radiation oncology and radiology. Brachytherapy publishes technical advances, original articles, reviews, and point/counterpoint on controversial issues. Original articles that address any aspect of brachytherapy are invited. Letters to the Editor-in-Chief are encouraged.