Efficacy of moderately hypofractionated simultaneous integrated boost intensity-modulated radiotherapy combined with temozolomide for the postoperative treatment of glioblastoma multiforme: a single-institution experience

Abstract

Purpose Despite recent advances in multimodal treatments, the prognosis of patients with glioblastoma multiforme (GBM) remains poor. The aim of this study was to evaluate the efficacy of moderately hypofractionated simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) combined with temozolomide (TMZ) for the postoperative treatment of GBM. Materials and methods From February 2012 to February 2018, 80 patients with newly diagnosed and histologically confirmed GBM in our institute were reviewed retrospectively. All patients underwent complete resection or partial resection surgery and then received hypofractionated SIB-IMRT with concomitant TMZ followed by adjuvant TMZ. A total dose of 64 Gy over 27 fractions was delivered to the gross tumor volume (GTV), clinical target volume 1 (CTV1) received 60 Gy over 27 fractions, and CTV2 received 54 Gy over 27 fractions. The progression-free survival (PFS) and overall survival (OS) rates and the toxicities were evaluated. Prognostic factors were analyzed using univariate and multivariate Cox models. Results The median follow-up was 16 months (range, 5~72 months). The median PFS was 15 months, and the 1-, 2-, and 3-year PFS rates were 56.0, 27.6, and 19.5%, respectively. The median OS was 21 months, and the 1-, 2-, 3-, and 5-year OS rates were 77.6, 41.6, 32.8, and 13.4%, respectively. The toxicities were mild and acceptable. Age, KPS scores and the total number of TMZ cycles were significant factors influencing patient survival. Conclusion Moderately hypofractionated SIB-IMRT combined with TMZ is a feasible and safe treatment option with mild toxicity and good PFS and OS.

Therapeutic Efficiency of Multiple Applications of Magnetic Hyperthermia Technique in Glioblastoma Using Aminosilane Coated Iron Oxide Nanoparticles: In Vitro and In Vivo Study

“…Fractionated use of radiotherapy (or multiple applications) improves overall survival in patients, however, even though it has been applied for decades, there is still no optimal dose fraction established, although evidences suggest that moderately hypofractionated radiotherapy causes a survival increasing from 12 to 16 months [82,83]. Similar to radiotherapy, there is still no optimal dose fraction established for MHT therapy, and further studies are necessary to establish the best AMF parameters, periodicity of application, SPION dose and fractionation of MHT application.…”

Survival of glioblastoma treated with a moderately escalated radiation dose—Results of a retrospective analysis

“…better OS. Zhong et al also reported improved PFS and OS following a moderately integrated radiation boost scheme (64 Gy over 27 fractions to GTV) in GBM patients [12]. In a study by Graf et al, the median survival time was 3.0 months for a radiation dose of 55 Gy or less, 8.6 months for doses between 56 and 65 Gy, and 9.6 months for a dose range between 66 and 75 Gy (p < 0.01) [20].…”

“…In the era of conformal and precise radiation, several studies tried to administer an escalated radiation dose to the GBM tumor surgical bed or residuum to improve local control [5,[7][8][9][10][11][12]. Milano et al investigated the pattern and timing of GBM treated by biopsy or resection followed by standard 60-Gy radiation and temozolomide (TMZ) therapy and found that 80% of recurrence still occurred in the primary tumor site [7].…”

“…Most of them failed to prolong survival through an escalated dose. However, two recent reports showed a positive prognostic effect of a moderately integrated radiation boost dose (> 60 Gy) with a superior local control, and this also translated to a better overall survival (OS) [11,12].…”

Radiotherapy and COVID-19 pandemic - a review of the current recommendations

“…Meta analysis by Liao et al showed that hypofractionated radiotherapy is efficacious for patients older than 70 years, while in younger and others with good prognostic factors is yet to be seen [12]. Balakrishnan reported mild acute and late toxicities in patients with glioblastoma treated with SIB intensity-modulated radiotherapy (IMRT) and TMZ [14].…”