Biology-Informed Target Delineation in High-Grade Gliomas—Balancing Precision and Preservation
Mené sur 154 patients atteints d'un gliome de haut grade (durée médiane de suivi : 22 mois ; âge médian : 51,5 ans ; 55,2 % d'hommes), cet essai randomisé évalue l'efficacité, du point de vue de la survie sans progression, d'une modification du volume-cible associée à une radiothérapie modérément hypofractionnée avec modulation d’intensité par rapport à une radiothérapie standard
Patients diagnosed with high-grade gliomas (HGGs) have overall poor prognoses, necessitating optimization of treatment strategies to improve tumor control as well as to reduce treatment-related toxicity and treatment burden. Both tumor progression and radiation treatments can contribute to worsening quality of life due to neurologic symptoms and neurocognitive issues, so the dual goals of reducing treatment-related toxicity and improving tumor control are both essential and require delicate balancing.Our current era of access to novel neuroimaging presents a path toward this balance. However, radiation treatment planning has not substantively harnessed this technology to work toward achieving these aims. In their recent study, Zhong et al simultaneously evaluated modified radiation dose and target delineation in a randomized clinical trial in the hopes of improving tumor control and reducing radiation-related toxicity to uninvolved brain tissue. At a single institution, 154 patients with HGGs were randomized to receive hypofractionated simultaneous boost intensity modulated radiation therapy (HSIB-IMRT) delivered to a neuroanatomically defined target volume vs conventionally fractionated radiotherapy to a standard target volume as defined by the Radiation Therapy Oncology Group. Although there were no significant differences in the primary end points (progression-free and overall survival) between the arms at a median follow-up of 22 months, it is difficult to draw actionable conclusions about the results given the fact that the study design modifies both dose and treatment volume simultaneously. However, this study highlights the important question of incorporating novel imaging techniques incorporating our understanding of both biology and neuroanatomy to rationally design target volumes for patients with HGGs.
JAMA Network Open , éditorial en libre accès, 2025