A pilot study of hypofractionated radiation therapy with temozolomide for adults with glioblastoma multiforme

Terasaki, Mizuhiko; Eto, Tomoko; Nakashima, Shinji; Okada, Yosuke; Ogo, Etsuyo; Sugita, Yasuo; Tokutomi, Takashi; Shigemori, Minoru

doi:10.1007/s11060-010-0306-6

Cited by 34 publications

(27 citation statements)

References 22 publications

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“…The Japanese series reported by Terasaki et al [35] showed an MS of 15.6 months despite using a relatively modest dose of 45 Gy in 15 fractions. The series from McGill University reported an MS of 14.6 months for the entire study population [34].…”

Section: Discussionmentioning

confidence: 95%

“…At a median follow-up of 20 months, the median OS was 15.6 months. No significant increase in toxicity was observed [35].…”

Section: Hingorani W P Colley S Dixit and A M Beavis E776mentioning

confidence: 87%

“…Terasaki et al [35] reported on a Japanese prospective series of 26 patients with GBM treated with HFRT and TMZ. Patients received 45 Gy in 15 fractions over 3 weeks with concomitant and adjuvant TMZ, and were treated with standard three-dimensional conformal RT.…”

Section: Hingorani W P Colley S Dixit and A M Beavis E776mentioning

confidence: 99%

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Hypofractionated radiotherapy for glioblastoma: strategy for poor-risk patients or hope for the future?

Hingorani¹,

Colley²,

Dixit³

et al. 2012

BJR

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ABSTRACT. The prognosis of patients with glioblastoma (GBM) remains poor, and the use of hyperfractionation or dose escalation beyond 60 Gy has not conferred any survival benefit. More recently, hypofractionated radiotherapy (HFRT) has been employed as a novel approach for achieving dose escalation, with interesting results. We present here a systematic overview of the role and development of HFRT as a possible therapeutic strategy in patients with GBM. We searched the PubMed database for studies published since 1990 that reported on the tolerance, safety and survival outcomes after HFRT. These studies reported on the paradox of improved survival in patients developing central radionecrosis within the high-dose volume. Most series reported no significant increase in early or late toxicity, except for one study that reported visual loss in one patient at 7 months after treatment. More recently, studies of HFRT combined with concurrent temozolomide (TMZ) reported a trend towards improved survival compared with historical controls, with a few studies reporting a median survival of approximately 20 months. The interpretation of data from the above studies is limited by the heterogeneities of patient population and the significant variation in the range of employed dose schedules. However, high-dose HFRT using intensity-modulated radiotherapy appears to be a safe and feasible therapeutic option. There is a suggestion of improved outcomes on combining HFRT with TMZ, which warrants further investigation in a randomised trial.

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Section: Discussionmentioning

confidence: 95%

“…At a median follow-up of 20 months, the median OS was 15.6 months. No significant increase in toxicity was observed [35].…”

Section: Hingorani W P Colley S Dixit and A M Beavis E776mentioning

confidence: 87%

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Hypofractionated radiotherapy for glioblastoma: strategy for poor-risk patients or hope for the future?

Hingorani¹,

Colley²,

Dixit³

et al. 2012

BJR

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“…In a phase I dose-escalation study, the hematological tolerance of moderately hypofractionated radiotherapy (2.6 Gy/fr., total dose 65 Gy) with concurrent temozolomide (TMZ) was found to be very good [31]. In another study of hypofractionated radiotherapy (3 Gy fr., total dose 45 Gy) with TMZ, the regimen was also well-tolerated; grade 2 neutropenia occurred in 10 patients (38%) [32]. Early hematological tolerance of hypofractionated regimen (3/6 Gy/fr., total dose 30/60 Gy) with concurrent and adjuvant TMZ was assessed in a phase II trial conducted by Ney et al [33].…”

Section: Clinical Studiesmentioning

confidence: 99%

Hematological Toxicity of Hypofractionated Radiotherapy: A Review of the Available Evidence

Spałek

2018

Oncol Res Treat

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Hypofractionated radiotherapy is commonly used to treat many cancers. The number of indications for this fractionation schedule is increasing. Knowledge of the potential hematological toxicity arising from hypofractionated irradiation is vital since many patients receive further systemic treatment. This review analyzes the available evidence on the effect of hypofractionated radiotherapy on hematological toxicity. However, radiobiological data on bone marrow responses to high doses of radiation per fraction are sparse. Additional biological effects may also play an significant role in bone marrow function and recovery after hypofractionated radiotherapy. Clinical data show a good early hematological tolerance of hypofractionated radiotherapy (both large field and for stereotactic body radiotherapy). There are, however, no data available that assess late hematological toxicity. Evidence on acute hematological toxicity after hypofractionated radiotherapy does not suggest any significant impact of altered fractionation on early treatment tolerance, although further research to assess this problem is needed. The effect of hypofractionation on late hematological tolerance is unknown because the data are still lacking.

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“…It is not surprising then that there has been a rekindled interest in exploring hypofractionation regimens that, even if equivalent in effectiveness, would be preferable to conventional ones because of their shorter duration in patients with a terminal disease [7–18]. Moreover hypofractionation is associated with reduced costs compared to standard fractionation delivered with the same algorithm.…”

Section: Introductionmentioning

confidence: 99%

Hypofractionated intensity modulated radiotherapy with temozolomide in newly diagnosed glioblastoma multiforme

Ammirati

Chotai

Newton

et al. 2014

Journal of Clinical Neuroscience

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We conducted a phase I study to determine (a) the maximum tolerated dose of peri-radiation therapy temozolomide (TMZ) and (b) the safety of a selected hypofractionated intensity modulated radiation therapy (HIMRT) regimen in glioblastoma multiforme (GBM) patients. Patients with histological diagnosis of GBM, Karnofsky performance status (KPS)≥60 and adequate bone marrow function were eligible for the study. All patients received peri-radiation TMZ; 1 week before the beginning of radiation therapy (RT), 1 week after RT and for 3 weeks during RT. Standard 75 mg/m2/day dose was administered to all patients 1 week post-RT. Dose escalation was commenced at level I: 50 mg/m2/day, level II: 65 mg/m2/day and level III: 75 mg/m2/day for 4 weeks. HIMRT was delivered at 52.5 Gy in 15 fractions to the contrast enhancing lesion (or surgical cavity) plus the surrounding edema plus a 2 cm margin. Six men and three women with a median age of 67 years (range, 44–81) and a median KPS of 80 (range, 80–90) were enrolled. Three patients were accrued at each TMZ dose level. Median follow-up was 10 months (range, 1–15). Median progression free survival was 3.9 months (95% confidence interval [CI]: 0.9–7.4; range, 0.9–9.9 months) and the overall survival 12.7 months (95% CI: 2.5–17.6; range, 2.5–20.7 months). Time spent in a KPS ≥70 was 8.1 months (95% CI: 2.4–15.6; range, 2.4–16 months). No instance of irreversible grade 3 or higher acute toxicity was noted. HIMRT at 52.5 Gy in 15 fractions with peri-RT TMZ at a maximum tolerated dose of 75 mg/m2/day for 5 weeks is well tolerated and is able to abate treatment time for these patients.

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A pilot study of hypofractionated radiation therapy with temozolomide for adults with glioblastoma multiforme

Cited by 34 publications

References 22 publications

Hypofractionated radiotherapy for glioblastoma: strategy for poor-risk patients or hope for the future?

Hypofractionated radiotherapy for glioblastoma: strategy for poor-risk patients or hope for the future?

Hematological Toxicity of Hypofractionated Radiotherapy: A Review of the Available Evidence

Hypofractionated intensity modulated radiotherapy with temozolomide in newly diagnosed glioblastoma multiforme

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