ESTRO-ACROP guidelines: Gliobastoma
ESTRO-ACROP guideline “target delineation of glioblastomas”
Section snippets
Methods and materials
A literature search was conducted in MEDLINE PubMed that evaluated adults with GBM. The search focused on randomised, prospective and retrospective trials published in English (all sample sizes were considered). Both MeSH terms and text words were used and the following search strategy was applied: (”Glioblastoma/radiotherapy” [MeSH] OR “glioblastoma” OR “malignant glioma” OR high-grade glioma) AND ((delineation) OR (target volume) OR (CTV) OR (PTV) OR (margin) OR (recurrence pattern) OR
Preparation
To ensure accurate re-positioning the patient’s head should be immobilized using an individually adapted mask system. Thermoplastic systems are the most widely used and can be prepared at the same appointment as the planning CT scan. A flat position with the head in neutral is the most widely accepted practice as it is most comfortable for the patient. A CT scan should be obtained using 1–3 mm slice thickness from the vertex to the lower border of C3. As GBM can grow rapidly an up-to-date
Conclusions
More accurate and precise target delineation guidelines for GBM should help to promote standardisation and uniformity (see Fig. 1 for a sample case and a flowchart in Fig. 2). Currently, while a number of aspects of the delineation technique are evidence based, many arise from consensus practice.
While recognising that there is a range of approaches to defining the target volume in GBM patients, the ACROP guideline committee proposes the following pragmatic algorithm:
- •
Immobilisation with a
Preparation of the guideline
The guideline was prepared following the ESTRO SOP for guidelines and is an expert guideline. The writing committee consisted of the following experts: M.N. coordinated the guideline panel and drafted the manuscript. M.B., A.C., S.E.C., S.C.E., A.F., A.L.G., F.J.L., G.M., R.M., U.R., S.C.S. and D.C.W. were part of the expert panel and participated in the preparation of the manuscript. C.B. initiated the guideline, participated in its conception as well as the preparation of the manuscript. All
Guideline update
This guideline is planned to be updated within a 2 year-time frame unless there are fundamental scientific changes which require an earlier update. Amendments will be made if changes are minor but of clinical significance.
Conflicts of interest
The authors declare that they have no competing interests.
Disclaimer
ESTRO cannot endorse all statements or opinions made on the guidelines. Regardless of the vast professional knowledge and scientific expertise in the field of radiation oncology that ESTRO possesses, the Society cannot inspect all information to determine the truthfulness, accuracy, reliability, completeness or relevancy thereof. Under no circumstances will ESTRO be held liable for any decision taken or acted upon as a result of reliance on the content of the guidelines.
The component
References (50)
- et al.
Intensity-modulated radiation therapy in newly diagnosed glioblastoma: a systematic review on clinical and technical issues
Radiother Oncol
(2010) - et al.
Quality assurance of the EORTC 26981/22981; NCIC CE3 intergroup trial on radiotherapy with or without temozolomide for newly-diagnosed glioblastoma multiforme: the individual case review
Eur J Cancer
(2004) - et al.
Repositioning accuracy of two different mask systems-3D revisited: comparison using true 3D/3D matching with cone-beam CT
Int J Radiat Oncol Biol Phys
(2006) - et al.
Evaluation of peritumoral edema in the delineation of radiotherapy clinical target volumes for glioblastoma
Int J Radiat Oncol Biol Phys
(2007) - et al.
Tolerance of normal tissue to therapeutic irradiation
Int J Radiat Oncol Biol Phys
(1991) - et al.
Supratentorial malignant glioma: patterns of recurrence and implications for external beam local treatment
Int J Radiat Oncol Biol Phys
(1992) - et al.
Neuropsychometric evaluation of long-term survivors of adult brain tumours: relationship with tumour and treatment parameters
Radiother Oncol
(1996) - et al.
An interindividual comparison of O-(2-[18F]fluoroethyl)-l-tyrosine (FET)- and l-[methyl-11C]methionine (MET)-PET in patients with brain gliomas and metastases
Int J Radiat Oncol Biol Phys
(2011) - et al.
Radiation therapy treatment planning in supratentorial glioblastoma multiforme: an analysis based on post mortem topographic anatomy with CT correlations
Int J Radiat Oncol Biol Phys
(1989) - et al.
Malignant glioma: patterns of failure following individually tailored limited volume irradiation
Radiother Oncol
(1994)