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@ARTICLE{Guberina:276773,
      author       = {N. Guberina and F. Padeberg and C. Pöttgen and M. Guberina
                      and L. Lazaridis and R. Jabbarli and C. Deuschl and K.
                      Herrmann and T. Blau and K. H. Wrede and K. Keyvani and B.
                      Scheffler$^*$ and J. Hense and J. P. Layer and M. Glas and
                      U. Sure and M. Stuschke$^*$},
      title        = {{L}ocation of {R}ecurrences after {T}rimodality {T}reatment
                      for {G}lioblastoma with {R}espect to the {D}elivered
                      {R}adiation {D}ose {D}istribution and {I}ts {I}nfluence on
                      {P}rognosis.},
      journal      = {Cancers},
      volume       = {15},
      number       = {11},
      issn         = {2072-6694},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DKFZ-2023-01154},
      pages        = {2982},
      year         = {2023},
      abstract     = {While prognosis of glioblastoma after trimodality treatment
                      is well examined, recurrence pattern with respect to the
                      delivered dose distribution is less well described.
                      Therefore, here we examine the gain of additional margins
                      around the resection cavity and gross-residual-tumor.All
                      recurrent glioblastomas initially treated with
                      radiochemotherapy after neurosurgery were included. The
                      percentage overlap of the recurrence with the gross tumor
                      volume (GTV) expanded by varying margins (10 mm to 20 mm)
                      and with the $95\%$ and $90\%$ isodose was measured.
                      Competing-risks analysis was performed in dependence on
                      recurrence pattern.Expanding the margins from 10 mm to 15
                      mm, to 20 mm, to the $95\%-$ and $90\%$ isodose of the
                      delivered dose distribution with a median margin of 27 mm
                      did moderately increase the proportion of relative in-field
                      recurrence volume from $64\%$ to $68\%,$ $70\%,$ $88\%$ and
                      $88\%$ (p < 0.0001). Overall survival of patients with
                      in-and out-field recurrence was similar (p = 0.7053). The
                      only prognostic factor significantly associated with
                      out-field recurrence was multifocality of recurrence (p =
                      0.0037). Cumulative incidences of in-field recurrences at 24
                      months were $60\%,$ $22\%$ and $11\%$ for recurrences
                      located within a 10 mm margin, outside a 10 mm margin but
                      within the $95\%$ isodose, or outside the $95\%$ isodose (p
                      < 0.0001). Survival from recurrence was improved after
                      complete resection (p = 0.0069). Integrating these data into
                      a concurrent-risk model shows that extending margins beyond
                      10 mm has only small effects on survival hardly detectable
                      by clinical trials.Two-thirds of recurrences were observed
                      within a 10 mm margin around the GTV. Smaller margins reduce
                      normal brain radiation exposure allowing for more extensive
                      salvage radiation therapy options in case of recurrence.
                      Prospective trials using margins smaller than 20 mm around
                      the GTV are warranted.},
      keywords     = {glioblastoma (Other) / intensity modulated radiation
                      therapy (IMRT) (Other) / neurosurgery (Other) / recurrence
                      pattern (Other) / volumetric modulated arc therapy (VMAT)
                      (Other)},
      cin          = {ED01},
      ddc          = {610},
      cid          = {I:(DE-He78)ED01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37296942},
      pmc          = {pmc:PMC10252044},
      doi          = {10.3390/cancers15112982},
      url          = {https://inrepo02.dkfz.de/record/276773},
}