Outcome and patterns of failure following limited-volume irradiation for malignant astrocytomas

Garden, Adam S.; Maor, Moshe; Yung, W.K. Alfred; Bruner, Janet M.; Woo, Shiao Y.; Moser, Richard P.; Lee, Ya Yen

doi:10.1016/0167-8140(91)90143-5

Cited by 132 publications

(63 citation statements)

References 14 publications

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“…Chemotherapeutic agents included Temozolomide (13), Thalidomide (3), Poly ICLC (6), Zarnestra (1), Tarceva (1), Accutane (1) and Celebrex (1), and 2 patients underwent carbogen breathing during delivery of RT following injection of bovine hemoglobin (HbOC-201). Chemotherapy was given either concurrently (15) or adjuvantly (8).…”

Section: Methodsmentioning

confidence: 99%

“…Computerized tomography (CT) and magnetic resonance imaging (MRI) are currently used to delineate the target volume for high grade gliomas with MRI providing superior soft tissue contrast [5][6][7]. Target volumes for 3D conformal radiation therapy (3D-CRT) are defined to cover the Gadolinium contrast enhancing region on T1-weighted images obtained from MRI with a uniform margin of 1 to 4 cm [1,[8][9][10] and/or the area of hyperintense lesion on T2-weighted MRI enlarged by several centimeters [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Patterns of Recurrence Analysis in Newly Diagnosed Glioblastoma Multiforme After Three-Dimensional Conformal Radiation Therapy With Respect to Pre–Radiation Therapy Magnetic Resonance Spectroscopic Findings

Park

Tamai

Lee

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To determine whether the combined MRI and MR spectroscopy imaging (MRSI) prior to radiation therapy (RT) is valuable for RT target definition, and to evaluate the feasibility of replacing the current definition of uniform margins by custom shaped margins based on the information from MRI and MRSI.Methods and Materials-Twenty three GBM patients underwent MRI and MRSI within 4 weeks after surgery but before the initiation of RT and at two month follow-up (FU) intervals thereafter. MRSI data were quantified on the basis of a Choline-to-NAA Index (CNI) as a measure of spectroscopic abnormality. A combined anatomic and metabolic ROI (MRI/S) consisting of T2-weighted hyperintensity, contrast enhancement (CE), resection cavity and CNI2 based on the pre-RT imaging was compared to CNI2 extent and RT dose distribution. The spatial relationship of the pre-RT MRI/S and the RT dose volume was compared to the extent of CE at each FU.Results-Nine patients showed new or increased CE during FU, and 14 patients were either stable or had decreased CE. New or increased areas of CE occurred within CNI2 that was covered by 60 Gy in six patients and within the CNI2 that was not entirely covered by 60 Gy in three patients. New or increased CE resided within the pre-RT MRI/S lesion in 89 % (8/9) of the patients with new or increased CE.Conclusion-These data indicate that the definition of RT target volumes according to the combined morphologic and metabolic abnormality may be sufficient for RT targeting.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patterns of Recurrence Analysis in Newly Diagnosed Glioblastoma Multiforme After Three-Dimensional Conformal Radiation Therapy With Respect to Pre–Radiation Therapy Magnetic Resonance Spectroscopic Findings

Park

Tamai

Lee

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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“…The rate of recurrence outside the tumour bed is low and mostly occurs with or after recurrence of the original disease [14]. Brandes et al [15] has recently reported the pattern of failure in 95 patients with newly diagnosed GBM treated with radiotherapy plus .…”

Section: Discussionmentioning

confidence: 99%

Phase I Study of Hypofractionated Intensity Modulated Radiation Therapy with Concurrent and Adjuvant Temozolomide in Patients with Glioblastoma Multiforme

Jastaniyah¹,

Le²,

Pervez³

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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Purpose: To determine the safety and efficacy of hypofractionated intensity modulated radiation therapy (Hypo-IMRT) using helical tomotherapy (HT) with concurrent low dose temozolomide (TMZ) followed by adjuvant TMZ in patients with glioblastoma multiforme (GBM). Methods and materials:Adult patients with GBM and KPS > 70 were prospectively enrolled between 2005 and 2007 in this phase I study. The Fibonacci dose escalation protocol was implemented to establish a safe radiation fractionation regimen. The protocol defined radiation therapy (RT) dose level I as 54.4 Gy in 20 fractions over 4 weeks and dose level II as 60 Gy in 22 fractions over 4.5 weeks. Concurrent TMZ followed by adjuvant TMZ was given according to the Stupp regimen. The primary endpoints were feasibility and safety of Hypo-IMRT with concurrent TMZ. Secondary endpoints included progression free survival (PFS), pattern of failure, overall survival (OS) and incidence of pseudoprogression. The latter was defined as clinical or radiological suggestion of tumour progression within three months of radiation completion followed by spontaneous recovery of the patient.Results: A total of 25 patients were prospectively enrolled with a median follow-up of 12.4 months. The median age at diagnosis was 53 years. Based on recursive partitioning analysis (RPA) criteria, 16%, 52% and 32% of the patients were RPA class III, class IV and class V, respectively. All patients completed concurrent RT and TMZ, and 19 patients (76.0%) received adjuvant TMZ. The median OS was 15.67 months (95% CI 11.56 -20.04) and the median PFS was 6.7 months (95% CI 4.0 -14.0). The median time between surgery and start of RT was 44 days (range of 28 to 77 days). Delaying radiation therapy by more than 6 weeks after surgery was an independent prognostic factor associated with a worse OS (4.0 vs. 16.1 months, P = 0.027). All recurrences occurred within 2 cm of the original gross tumour volume (GTV). No cases of pseudoprogression were identified in our cohort of patients. Three patients tolerated dose level I with no dose limiting toxicity and hence the remainder of the patients were treated with dose level II according to the dose escalation protocol. Grade 3-4 hematological toxicity was limited to two patients and one patient developed Grade 4 Pneumocystis jiroveci pneumonia. Conclusion: Hypo-IMRT using HT given with concurrent TMZ is feasible and safe. The median OS and PFS are comparable to those observed with conventional fractionation. Hypofractionated radiation therapy offers the advantage of a shorter treatment period which is imperative in this group of patients with limited life expectancy.

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“…It was not until the early 1970's that partial brain treatment became a viable option with the introduction of CT which heralded a dramatic change in the diagnostic evaluation and treatment principles of gliomas. The correlation of CT imaging and histological data in conjunction with clinical data demonstrating 80% of local recurrence arising within 2 cm of the original tumor as defined by CT, paved the foundation for successful partial brain treatment [2,3,5,14,[23][24][25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

“…The foundation of radiation treatment planning for GBM is based on landmark studies demonstrating predilection for central recurrence and data correlating pathologic findings with imaging abnormalities [2][3][4][5]. Contemporary radiation therapy planning for high grade gliomas involves identifying tumor volumes on various MRI sequences.…”

Section: Introductionmentioning

confidence: 99%

Comparison of T2 and FLAIR Imaging for Target Delineation in High Grade Gliomas

Stall

Zach

Ning

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Outcome and patterns of failure following limited-volume irradiation for malignant astrocytomas

Cited by 132 publications

References 14 publications

Patterns of Recurrence Analysis in Newly Diagnosed Glioblastoma Multiforme After Three-Dimensional Conformal Radiation Therapy With Respect to Pre–Radiation Therapy Magnetic Resonance Spectroscopic Findings

Patterns of Recurrence Analysis in Newly Diagnosed Glioblastoma Multiforme After Three-Dimensional Conformal Radiation Therapy With Respect to Pre–Radiation Therapy Magnetic Resonance Spectroscopic Findings

Phase I Study of Hypofractionated Intensity Modulated Radiation Therapy with Concurrent and Adjuvant Temozolomide in Patients with Glioblastoma Multiforme

Comparison of T2 and FLAIR Imaging for Target Delineation in High Grade Gliomas

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