Personalized approach to complex treatment of malignant glial tumors of the brain

Abstract

Relevance. Malignant glial tumors of the brain (MGBT) are characterized by an aggressive course, high recurrence rate and significant impact on the quality of life. Optimization of the resection volume and the use of modern methods of radiation and chemotherapy can improve oncological control and reduce treatment toxicity. Objective of the study. To evaluate the results of complex treatment of MGBT using individualized planning of radiation therapy and chemotherapy depending on the morphological and functional characteristics of the tumor. Materials and methods. The study included 174 patients with MGBT. The sizes of the primary and residual tumor according to MRI, the volume of resection, the timing of the start and technique of RT (3D-CRT, IMRT, VMAT), the use of radiomodifiers, the dynamics of the tumor volume during RT, early and late toxicity were assessed. Statistical processing was performed using the χ² test and the Cramér’s V coefficient. Results and discussion. Complete tumor removal was achieved in 10.3% of patients, with a residual tumor remaining in 89.7%. The most frequently used methods were 3D-CRT (58%), IMRT – 35.6%, VMAT – 5.2%. Temozolomide was used in 33% of patients, mainly in anaplastic astrocytoma and glioblastoma (p=0.0011). During inter-course MRI control in 30 patients, the median decrease in GTV volume was 35.38%, with a simultaneous decrease in V10 for healthy tissues by 19.02%. Early complications included hair loss (92.53%), dry epitheliitis (79.89%), gastrointestinal reactions (83.33%); late complications included headaches (87.93%), memory loss (54.02%), epilepsy (52.30%). Conclusion. Personalized RT planning with perfusion MRI allows to reduce the volume of healthy tissues irradiated without losing oncological control. The use of modern RT techniques and temozolomide improves local control and survival in CT brain tumors, but the high frequency of complications requires the development of individual protocols for prevention and correction of toxicity.

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