Comparison of Quality of Life in Postoperative High-Grade Glioma Patients Treated Using EORTC and RTOG Target Delineation Techniques for Postoperative Radiotherapy.

Abstract

Introduction: High-grade gliomas (HGGs) have dismal prognosis even with multimodality treatment entailing surgery, radiotherapy, and chemotherapy. Hence, assessment of improvement in quality of life (QOL) for evaluating treatment is critical. Target delineation for radiotherapy in HGG is often done according to the European Organization for Research and Treatment of Cancer (EORTC) and Radiotherapy and Oncology Group (RTOG) contouring guidelines, which differs on exclusion and inclusion of peritumoral edema believed to harbor malignant cells; the guidelines have not been prospectively compared for probable difference in QOL, considering the probable difference in treated volume.

Objective: This article compares QOL in HGG patients receiving postoperative radiotherapy using target volume delineation based on the RTOG or EORTC guidelines.

Materials and methods: In this single-center, prospective randomized exploratory study, postoperative HGG patients were randomized to either receive radiotherapy according to the EORTC guidelines of target delineation (60 Gy/30 fractions to tumor bed and residual tumor) or the RTOG guidelines (46 Gy/23fractions to tumor bed, residual tumor, and peritumoral edema with 14 Gy/7 fraction boost to the tumor bed and residual tumor) with concurrent temozolomide (TMZ) followed by 6 months of adjuvant TMZ. The aim and primary endpoint of the study was to assess and compare QOL between the arms. Descriptive statistics were used to convey demographic data, proportions for categorical variables, and mean, median, range, and standard deviation for continuous variables. Effect size was assessed using partial eta squared test where values of 0.01, 0.06, and 0.14 signify small, medium, and large effect size, respectively. Repeated measures analysis of variance test was used for comparison of means and assessment of QOL between the EORTC and RTOG groups at 6 months. Absolute volume of planning target volume (PTV) receiving 46 and 60 Gy were described, PTV 46/60 was also described in terms of % of whole brain volume.

Results: Eighteen patients underwent randomization (9 in EORTC and RTOG group each). Statistically significant improvement was noted in the overall posttreatment values in the physical well-being (PWB) domain ( p  = 0.007).

Conclusion: This is the first study to compare the EORTC and RTOG delineation techniques in terms of QOL. No significant differences in QOL were noted between the two arms. Significant improvement was noted posttreatment in PWB of overall patients.