Optimal Timing of Whole-Brain Radiation Therapy Following Craniotomy for Cerebral Malignancies

Patel, Dhruv; Agarwal, Nitin; Tomei, Krystal L.; Hansberry, David R.; Goldstein, Ira M.

doi:10.1016/j.wneu.2015.03.052

Cited by 17 publications

(8 citation statements)

References 64 publications

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“…Although GBM had a relatively low reported incidence rate of 3 cases per 100,000 people in the United States and Europe, increased attention has been drawn into the development of new treatment approaches because of its poor prognosis with a median survival rate of 15 months (1). Standard treatment options comprise surgical resection, where possible, with adjuvant chemotherapy and/or radiation (2,3). However, current treatments and prognosis are highly dependent on the circumstantial glioma features including the tumor's anatomic topographic location that impedes radical resection, high tumor heterogeneity, cell infiltration to adjacent brain tissue and inherent resistance to chemotherapy (4).…”

Section: Introductionmentioning

confidence: 99%

Chemotherapeutic Delivery from a Self-Assembling Peptide Nanofiber Hydrogel for the Management of Glioblastoma

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Chemotherapeutic Delivery from a Self-Assembling Peptide Nanofiber Hydrogel for the Management of Glioblastoma

et al. 2018

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“…First, it allows for immediate delivery of radiation following operative cytoreduction and prior to cancer cell repopulation. 39 , 40 Second, it has minimal effects on healing tissue, permitting early initiation of systemic therapy. Third, it provides a highly conformal radiation dose-minimizing regional toxicity while allowing the treatment of large and irregular cavities.…”

Section: Discussionmentioning

confidence: 99%

Salvage brachytherapy for multiply recurrent metastatic brain tumors: A matched case analysis

Cantalino

Dee

et al. 2022

Neuro-Oncology Advances

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Introduction Patients with recurrent brain metastases who have exhausted external radiation options pose a treatment challenge in the setting of advances in systemic disease control which have improved quality of life and survival. Brachytherapy holds promise as salvage therapy given its ability to enforce surgical cytoreduction and minimize regional toxicity. This study investigates the role of salvage brachytherapy in maintaining local control for recurrent metastatic lesions. Methods We retrospectively reviewed our institution’s experience with brachytherapy in patients with multiply recurrent cerebral metastases who have exhausted external radiation treatment options (14 cases). The primary outcome of the study was freedom from local recurrence. To capture the nuances of tumor biology, we compared freedom from local recurrence achieved by brachytherapy to the preceding treatment for each patient. We further compared the response to brachytherapy in lung cancer patients (8) against a matched cohort of maximally radiated lung brain metastases (10 cases). Results Brachytherapy treatment conferred significantly longer freedom from local recurrence compared to prior treatments (median 7.39 vs. 5.51 months, p=0.011) for multiply recurrent brain metastases. Compared to an independent matched cohort, brachytherapy demonstrated superior freedom from local recurrence (median 8.49 vs. 1.61 months, p=0.004) and longer median overall survival (11.07 vs 5.93 months, p=.055), with comparable side effects. Conclusion Brachytherapy used as salvage treatment for select patients with a multiply recurrent oligometastatic brain metastasis in the setting of well-controlled systemic disease holds promise for improving local control in this challenging patient population.

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“…There are several possible explanations for the worse outcomes seen in patients with shorter TT. There is concern that starting radiation before the patient has fully recovered from surgery could result in impaired healing and an increase in radiation side effects (36–38). It is also probable that patients who start treatment sooner after surgery are chosen to do so based on the judgment of the clinician that they have more aggressive disease or worse functional status as a result of their disease.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Timing of Concurrent Chemoradiation in Patients With High-Grade Glioma in the Era of the Stupp Protocol

Warren

Liu

et al. 2019

Front. Oncol.

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Background: The purpose of this study is to provide a critical review of current evidence for the impact of time to initiation of chemoradiation on overall survival in patients with newly diagnosed high-grade gliomas treated with radiation and concurrent temozolomide chemotherapy. Methods: A literature search was conducted using PubMed/MEDLINE and EMBASE databases. Studies were included if they provided separate analysis for patients treated with current standard of care: radiation and concurrent temozolomide. Bias assessment was performed for each included study using the Newcastle-Ottawa Assessment Scale, with Karnofsky Performance Status (KPS) and extent of resection used for comparability. Results: The initial search yielded 575 citations. Based on the inclusion/exclusion criteria, a total of 10 retrospective cohort studies were included in this review for a total of 30,298 patients. Of these, one study described an indirect relationship between time to initiation of treatment and overall survival. One study found decreased survival only with patients with significantly longer time to treatment. Four studies found no significant effect of time to treatment on overall survival. The four remaining studies found that patients with moderate time to initiation had the best overall survival. Conclusion: This review provides evidence that moderate time to initiation of chemoradiotherapy in patients with high-grade gliomas does not lead to a significant decrease in overall survival, though the effect of significant delays in treatment initiation remains unclear.

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Optimal Timing of Whole-Brain Radiation Therapy Following Craniotomy for Cerebral Malignancies

Cited by 17 publications

References 64 publications

Chemotherapeutic Delivery from a Self-Assembling Peptide Nanofiber Hydrogel for the Management of Glioblastoma

Chemotherapeutic Delivery from a Self-Assembling Peptide Nanofiber Hydrogel for the Management of Glioblastoma

Salvage brachytherapy for multiply recurrent metastatic brain tumors: A matched case analysis

The Impact of Timing of Concurrent Chemoradiation in Patients With High-Grade Glioma in the Era of the Stupp Protocol

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