Quality of life outcomes in a phase 3 Randomized trial of optimization of treatment of advanced non–small cell lung cancer using radiation therapy and chemotherapy: IAEA …

Purpose/Objective (s): We sought to determine the pattern of recurrence of tumors treated with 5 fractions of stereotactic radiosurgery (SRS) with 5 mm margins delivered with concurrent and adjuvant temozolomide (TMZ) in newly diagnosed glioblastoma (GBM). Materials/Methods: Thirty adult patients with newly diagnosed supratentorial GBM were enrolled on an institutional review board approved protocol of 5 consecutive days of SRS in escalating doses in a 3+ 3 design on 4 dose levels: 25 Gy, 30 Gy, 35 Gy, and 40 Gy targeting the GTV of the resection cavity/residual tumor with a 5 mm CTV margin and 0 mm PTV margin. MRI T2 edema signal was not purposely targeted. In-field recurrences were scored if the initial site of recurrence was contained within the 95% prescription isodose line (IDL), which corresponds to 5 mm margin on the cavity/residual or if contiguous with tumors within the 95% IDL. Recurrent tumor located outside of the 95% IDL, between 5 and 20 mm from the cavity (and otherwise covered with typical 2 cm margins for IMRT), were scored as marginal. Recurrences presenting more than 20 mm away from the cavity were considered distal. Results: From 2010 to 2016, 26 patients had progressed and were eligible for pattern of recurrence analysis, with a median follow-up of 14 months (range 2-53). Seventeen out of 26 cases (65%) showed in-field recurrence within the 95% IDL, including one patient who also presented with a distal recurrence. Six patients (23%) showed purely distal recurrences, and 3 patients developed marginal failures (12%). Eight out of the 10 patients in the highest 40 Gy dose level recurred locally …