Intraoperative radiotherapy for glioblastoma: an international pooled analysis

Sarria, Gustavo R.; Sperk, Elena; Han, Xiudi; Sarria, Gustavo J; Wenz, Frederik; Brehmer, Stefanie; Fan, Bing; Min, Siming; Zhang, Hongjun; Qin, Shuang; Qiu, Xiaoguang; Hänggi, Daniel; Abo-Madyan, Yasser; Martínez, David Andina; Cabrera, Carla; Giordano, Frank A.

doi:10.1016/j.radonc.2019.09.023

Cited by 24 publications

(16 citation statements)

References 40 publications

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“…Therefore, increased attention should be given to exposed unaffected tissue. Based on published clinical experiences, an estimated 15 -20% grade 3 RN is to be expected after combining EBRT and IORT; however, no variables were individually assessed to determine which of them could mostly contribute to these events (14,15). These outcomes are closely bound to earlier dosimetric data, which described a direct relationship between larger applicator sizes and increased doses in depth (16).…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma

et al. 2021

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PurposeTo simulate and analyze the dosimetric differences of intraoperative radiotherapy (IORT) or pre-operative single-fraction stereotactic radiosurgery (SRS) in addition to post-operative external beam radiotherapy (EBRT) in Glioblastoma (GB).MethodsImaging series of previously treated patients with adjuvant radiochemotherapy were analyzed. For SRS target definition, pre-operative MRIs were co-registered to planning CT scans and a pre-operative T1-weighted gross target volume (GTV) plus a 2-mm planning target volume (PTV) were created. For IORT, a modified (m)GTV was expanded from the pre-operative volume, in order to mimic a round cavity as during IORT. Dose prescription was 20 Gy, homogeneously planned for SRS and calculated at the surface for IORT, to cover 99% and 90% of the volumes, respectively. For tumors > 2cm in maximum diameter, a 15 Gy dose was prescribed. Plan assessment was performed after calculating the 2-Gy equivalent doses (EQD2) for both boost modalities and including them into the EBRT plan. Main points of interest encompass differences in target coverage, brain volume receiving 12 Gy or more (V12), and doses to various organs-at-risk (OARs).ResultsSeventeen pre-delivered treatment plans were included in the study. The mean GTV was 21.72 cm3 (SD ± 19.36) and mGTV 29.64 cm3 (SD ± 25.64). The mean EBRT and SRS PTV were 254.09 (SD ± 80.0) and 36.20 cm3 (SD ± 31.48), respectively. Eight SRS plans were calculated to 15 Gy according to larger tumor sizes, while all IORT plans to 20 Gy. The mean EBRT D95 was 97.13% (SD ± 3.48) the SRS D99 99.91% (SD ± 0.35) and IORT D90 83.59% (SD ± 3.55). Accounting for only-boost approaches, the brain V12 was 49.68 cm3 (SD ± 26.70) and 16.94 cm3 (SD ± 13.33) (p<0.001) for SRS and IORT, respectively. After adding EBRT results respectively to SRS and IORT doses, significant lower doses were found in the latter for mean Dmax of chiasma (p=0.01), left optic nerve (p=0.023), right (p=0.008) and left retina (p<0.001). No significant differences were obtained for brainstem and cochleae.ConclusionDose escalation for Glioblastoma using IORT results in lower OAR exposure as conventional SRS.

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Section: Discussionmentioning

confidence: 99%

Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma

et al. 2021

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“…Representing a total of 51 patients, the median OS at 12, 24, and 36 months was 80%, 39%, and 26%, respectively. The overall PFS time was 11.4 months, with 12-, 24-, and 36-month rates of 46%, 29%, and 6%, respectively ( 32 ). Based on these preliminary findings, the final results of the phase III study (INTRAGO II) have been eagerly anticipated.…”

Section: Clinical Outcome Datamentioning

confidence: 99%

Intraoperative Radiotherapy in Brain Malignancies: Indications and Outcomes in Primary and Metastatic Brain Tumors

Cifarelli

Jacobson

2021

Front. Oncol.

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Despite the continued controversy over defining an optimal delivery mechanism, the critical role of adjuvant radiation in the management of surgically resected primary and metastatic brain tumors remains one of the universally accepted standards in neuro-oncology. Local disease control still ranks as a significant predictor of survival in both high-grade glioma and treated intracranial metastases with radiation treatment being essential in maximizing tumor control. As with the emergence and eventual acceptance of cranial stereotactic radiosurgery (SRS) following an era dominated by traditional radiotherapy, evidence to support the use of intraoperative radiotherapy (IORT) in brain tumors requiring surgical intervention continues to accumulate. While the clinical trial strategies in treating glioblastoma with IORT involve delivery of a boost of cavitary radiation prior to the planned standard external beam radiation, the use of IORT in metastatic disease offers the potential for dose escalation to the level needed for definitive adjuvant radiation, eliminating the need for additional episodes of care while providing local control equal or superior to that achieved with SRS in a single fraction. In this review, we explore the contemporary clinical data on IORT in the treatment of brain tumors along with a discussion of the unique dosimetric and radiobiological factors inherent in IORT that could account for favorable outcome data beyond those seen in other techniques.

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“…About 296,851 individuals in the global were diagnosed with GBM in 2018, of which 241,037 people died, resulting in roughly equal morbidity and mortality [2]. Present situation, radiotherapy [3], chemotherapy [4] and surgical resection [5] are still the most effective way of improving the survival rate of GBM patients. However, GBM is difficult to diagnose in the early stages due to its concealed location and uncommon clinical symptoms.…”

Section: Introductionmentioning

confidence: 99%

Identification of Key Genes and Signaling Pathways Associated with the Progression of Glioblastoma multiform

Vastrad¹,

Vastrad²,

Kotturshetti

2020

Preprint

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Genomic features have been gradually regarded as part of the basics to the clinical diagnosis, prognosis and treatment for glioblastoma multform (GBM). However, the molecular modifications taking place during the advancement of GBM remain unclear. Therefore, recognition of potential important genes and pathways in the gastric cancer progression is important to clinical practices. In the present study, gene expression dataset (GSE116520) of GBM were selected from the Gene Expression Omnibus (GEO) database and were further used to identify differentially expressed genes (DEGs). Then, pathway and Gene Ontology (GO) enrichment analyses were conducted, and a protein-protein interaction (PPI) network was constructed to explore the potential mechanism of GBM carcinogenesis. Significant modules were discovered using the PEWCC1 plugin for Cytoscape. In addition, a target gene - miRNA regulatory network and target gene - TF regulatory network in GBM were constructed using common deregulated miRNAs, TFs and DEGs. Finally, we carried on validation of hub genes by UALCAN, cBioporta, human protein atlas, ROC (Receiver operating characteristic) curve analysis, RT-PCR and immune infiltration analysis. The results indicated that a total of 947 differential expressed genes (DEGs) (477 up regulated and 470 down regulated) was identified in microarray profiles. Pathway enrichment analysis revealed that DEGs (up and down regulated) were mainly associated in reactive oxygen species degradation, ribosome, homocarnosine biosynthesis and GABAergic synapse, whereas GO enrichment analyses revealed that DEGs (up and down regulated) were mainly associated in macromolecule catabolic process, cytosolic part, synaptic signaling and synapse part as the main pathways associated in these processes. Finally, we filtered out hub genes, including MYC, ARRB1, RPL7A, SNAP25, SOD2, SVOP, ABCC3 and ABCA2, from the all networks. Validation of hub genes suggested the robustness of the above results. In conclusion, these results provided novel and reliable biomarkers for GBM, which will be useful for further clinical applications in GBM diagnosis, prognosis and targeted therapy.

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Intraoperative radiotherapy for glioblastoma: an international pooled analysis

Cited by 24 publications

References 40 publications

Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma

Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma

Intraoperative Radiotherapy in Brain Malignancies: Indications and Outcomes in Primary and Metastatic Brain Tumors

Identification of Key Genes and Signaling Pathways Associated with the Progression of Glioblastoma multiform

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