Association of 1p/19q Codeletion and Radiation Necrosis in Adult Cranial Gliomas After Proton or Photon Therapy

Sahaja Acharya, Clifford G. Robinson, Jeff M. Michalski, Dan Mullen, Todd DeWees, Jian L. Campian, Anupama Chundury, Beth Bottani, Dennis E. Hallahan, Jeffrey D. Bradley, Jiayi Huang

Research output: Contribution to journalArticle

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Abstract

Purpose: To analyze the incidence of and risk factors for clinically significant radiation necrosis (cRN) in adult cranial oligodendrogliomas and astrocytomas treated with proton or photon therapy. Methods and Materials: Between 2007 and 2015, 160 patients with grade 2 or 3 oligodendrogliomas (with 1p/19q codeletion, n = 53) or astrocytomas (without 1p/19q codeletion, n = 107) were treated with proton (n = 37) or photon (n = 123) therapy. Clinically significant radiation necrosis (RN) was defined as symptomatic RN or asymptomatic RN that resulted in surgery or bevacizumab administration. The cumulative incidence was calculated using competing risks. Risk factors were identified using Cox proportional hazards. Results: After a median follow-up period of 28.5 months, cRN developed in 18 patients (proton, 6; photon, 12). The 2-year cumulative incidence of cRN for proton and photon therapy was 18.7% (95% confidence interval [CI], 7.5%-33.8%) and 9.7% (95% CI, 5.1%-16%), respectively (P =.16). On multivariate analysis, risk factors for cRN included oligodendroglioma (hazard ratio [HR], 3.57; 95% CI, 1.38-9.25; P =.009) and higher prescription dose (in gray relative biological equivalents [GyRBE]) (HR, 1.30; 95% CI, 1.05-1.61; P =.015). The 2-year cumulative incidence of cRN in oligodendrogliomas and astrocytomas was 24.2% and 6.2%, respectively (P =.01). The relative volume (percentage) of brain receiving 60 GyRBE was a significant dosimetric predictor of cRN in oligodendrogliomas (HR, 1.11; 95% CI, 1.03-1.20; P =.005). Conclusions: The study showed that 1p/19q codeleted oligodendroglioma was a significant risk factor associated with cRN and the relative volume (percentage) of brain receiving 60 GyRBE was an important dosimetric predictor of cRN for oligodendroglioma patients. There is insufficient evidence at this time to conclude a significant difference in the incidence of cRN between proton and photon therapy.

Original languageEnglish (US)
Pages (from-to)334-343
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume101
Issue number2
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

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necrosis
Photons
Glioma
Protons
therapy
Necrosis
Oligodendroglioma
Radiation
protons
photons
radiation
confidence
incidence
hazards
Confidence Intervals
intervals
Astrocytoma
Therapeutics
Proton Therapy
Incidence

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Association of 1p/19q Codeletion and Radiation Necrosis in Adult Cranial Gliomas After Proton or Photon Therapy. / Acharya, Sahaja; Robinson, Clifford G.; Michalski, Jeff M.; Mullen, Dan; DeWees, Todd; Campian, Jian L.; Chundury, Anupama; Bottani, Beth; Hallahan, Dennis E.; Bradley, Jeffrey D.; Huang, Jiayi.

In: International Journal of Radiation Oncology Biology Physics, Vol. 101, No. 2, 01.06.2018, p. 334-343.

Research output: Contribution to journalArticle

Acharya, S, Robinson, CG, Michalski, JM, Mullen, D, DeWees, T, Campian, JL, Chundury, A, Bottani, B, Hallahan, DE, Bradley, JD & Huang, J 2018, 'Association of 1p/19q Codeletion and Radiation Necrosis in Adult Cranial Gliomas After Proton or Photon Therapy', International Journal of Radiation Oncology Biology Physics, vol. 101, no. 2, pp. 334-343. https://doi.org/10.1016/j.ijrobp.2018.01.099
Acharya, Sahaja ; Robinson, Clifford G. ; Michalski, Jeff M. ; Mullen, Dan ; DeWees, Todd ; Campian, Jian L. ; Chundury, Anupama ; Bottani, Beth ; Hallahan, Dennis E. ; Bradley, Jeffrey D. ; Huang, Jiayi. / Association of 1p/19q Codeletion and Radiation Necrosis in Adult Cranial Gliomas After Proton or Photon Therapy. In: International Journal of Radiation Oncology Biology Physics. 2018 ; Vol. 101, No. 2. pp. 334-343.
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abstract = "Purpose: To analyze the incidence of and risk factors for clinically significant radiation necrosis (cRN) in adult cranial oligodendrogliomas and astrocytomas treated with proton or photon therapy. Methods and Materials: Between 2007 and 2015, 160 patients with grade 2 or 3 oligodendrogliomas (with 1p/19q codeletion, n = 53) or astrocytomas (without 1p/19q codeletion, n = 107) were treated with proton (n = 37) or photon (n = 123) therapy. Clinically significant radiation necrosis (RN) was defined as symptomatic RN or asymptomatic RN that resulted in surgery or bevacizumab administration. The cumulative incidence was calculated using competing risks. Risk factors were identified using Cox proportional hazards. Results: After a median follow-up period of 28.5 months, cRN developed in 18 patients (proton, 6; photon, 12). The 2-year cumulative incidence of cRN for proton and photon therapy was 18.7{\%} (95{\%} confidence interval [CI], 7.5{\%}-33.8{\%}) and 9.7{\%} (95{\%} CI, 5.1{\%}-16{\%}), respectively (P =.16). On multivariate analysis, risk factors for cRN included oligodendroglioma (hazard ratio [HR], 3.57; 95{\%} CI, 1.38-9.25; P =.009) and higher prescription dose (in gray relative biological equivalents [GyRBE]) (HR, 1.30; 95{\%} CI, 1.05-1.61; P =.015). The 2-year cumulative incidence of cRN in oligodendrogliomas and astrocytomas was 24.2{\%} and 6.2{\%}, respectively (P =.01). The relative volume (percentage) of brain receiving 60 GyRBE was a significant dosimetric predictor of cRN in oligodendrogliomas (HR, 1.11; 95{\%} CI, 1.03-1.20; P =.005). Conclusions: The study showed that 1p/19q codeleted oligodendroglioma was a significant risk factor associated with cRN and the relative volume (percentage) of brain receiving 60 GyRBE was an important dosimetric predictor of cRN for oligodendroglioma patients. There is insufficient evidence at this time to conclude a significant difference in the incidence of cRN between proton and photon therapy.",
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T1 - Association of 1p/19q Codeletion and Radiation Necrosis in Adult Cranial Gliomas After Proton or Photon Therapy

AU - Acharya, Sahaja

AU - Robinson, Clifford G.

AU - Michalski, Jeff M.

AU - Mullen, Dan

AU - DeWees, Todd

AU - Campian, Jian L.

AU - Chundury, Anupama

AU - Bottani, Beth

AU - Hallahan, Dennis E.

AU - Bradley, Jeffrey D.

AU - Huang, Jiayi

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Purpose: To analyze the incidence of and risk factors for clinically significant radiation necrosis (cRN) in adult cranial oligodendrogliomas and astrocytomas treated with proton or photon therapy. Methods and Materials: Between 2007 and 2015, 160 patients with grade 2 or 3 oligodendrogliomas (with 1p/19q codeletion, n = 53) or astrocytomas (without 1p/19q codeletion, n = 107) were treated with proton (n = 37) or photon (n = 123) therapy. Clinically significant radiation necrosis (RN) was defined as symptomatic RN or asymptomatic RN that resulted in surgery or bevacizumab administration. The cumulative incidence was calculated using competing risks. Risk factors were identified using Cox proportional hazards. Results: After a median follow-up period of 28.5 months, cRN developed in 18 patients (proton, 6; photon, 12). The 2-year cumulative incidence of cRN for proton and photon therapy was 18.7% (95% confidence interval [CI], 7.5%-33.8%) and 9.7% (95% CI, 5.1%-16%), respectively (P =.16). On multivariate analysis, risk factors for cRN included oligodendroglioma (hazard ratio [HR], 3.57; 95% CI, 1.38-9.25; P =.009) and higher prescription dose (in gray relative biological equivalents [GyRBE]) (HR, 1.30; 95% CI, 1.05-1.61; P =.015). The 2-year cumulative incidence of cRN in oligodendrogliomas and astrocytomas was 24.2% and 6.2%, respectively (P =.01). The relative volume (percentage) of brain receiving 60 GyRBE was a significant dosimetric predictor of cRN in oligodendrogliomas (HR, 1.11; 95% CI, 1.03-1.20; P =.005). Conclusions: The study showed that 1p/19q codeleted oligodendroglioma was a significant risk factor associated with cRN and the relative volume (percentage) of brain receiving 60 GyRBE was an important dosimetric predictor of cRN for oligodendroglioma patients. There is insufficient evidence at this time to conclude a significant difference in the incidence of cRN between proton and photon therapy.

AB - Purpose: To analyze the incidence of and risk factors for clinically significant radiation necrosis (cRN) in adult cranial oligodendrogliomas and astrocytomas treated with proton or photon therapy. Methods and Materials: Between 2007 and 2015, 160 patients with grade 2 or 3 oligodendrogliomas (with 1p/19q codeletion, n = 53) or astrocytomas (without 1p/19q codeletion, n = 107) were treated with proton (n = 37) or photon (n = 123) therapy. Clinically significant radiation necrosis (RN) was defined as symptomatic RN or asymptomatic RN that resulted in surgery or bevacizumab administration. The cumulative incidence was calculated using competing risks. Risk factors were identified using Cox proportional hazards. Results: After a median follow-up period of 28.5 months, cRN developed in 18 patients (proton, 6; photon, 12). The 2-year cumulative incidence of cRN for proton and photon therapy was 18.7% (95% confidence interval [CI], 7.5%-33.8%) and 9.7% (95% CI, 5.1%-16%), respectively (P =.16). On multivariate analysis, risk factors for cRN included oligodendroglioma (hazard ratio [HR], 3.57; 95% CI, 1.38-9.25; P =.009) and higher prescription dose (in gray relative biological equivalents [GyRBE]) (HR, 1.30; 95% CI, 1.05-1.61; P =.015). The 2-year cumulative incidence of cRN in oligodendrogliomas and astrocytomas was 24.2% and 6.2%, respectively (P =.01). The relative volume (percentage) of brain receiving 60 GyRBE was a significant dosimetric predictor of cRN in oligodendrogliomas (HR, 1.11; 95% CI, 1.03-1.20; P =.005). Conclusions: The study showed that 1p/19q codeleted oligodendroglioma was a significant risk factor associated with cRN and the relative volume (percentage) of brain receiving 60 GyRBE was an important dosimetric predictor of cRN for oligodendroglioma patients. There is insufficient evidence at this time to conclude a significant difference in the incidence of cRN between proton and photon therapy.

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