Patterns of failure for glioblastoma multiforme following limited-margin radiation and concurrent temozolomide

Gebhardt, Brian J.; Dobelbower, M.C.; Ennis, William H; Bag, Asim K.; Markert, James M.; Fiveash, John B.

doi:10.1186/1748-717x-9-130

Cited by 124 publications

(72 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further exploring of this area is necessary. Furthermore, the size and role of the optimal radiotherapy margins are also a matter of debate [52, 53]. This is of particular importance in recurrent glioblastoma, where we have significantly less experience.…”

Section: Discussionmentioning

confidence: 99%

Current status and perspectives of interventional clinical trials for glioblastoma – analysis of ClinicalTrials.gov

et al. 2017

View full text Add to dashboard Cite

The records of 208.777 (100%) clinical trials registered at ClinicalTrials.gov were downloaded on the 19th of February 2016. Phase II and III trials including patients with glioblastoma were selected for further classification and analysis. Based on the disease settings, trials were classified into three groups: newly diagnosed glioblastoma, recurrent disease and trials with no differentiation according to disease setting. Furthermore, we categorized trials according to the experimental interventions, the primary sponsor, the source of financial support and trial design elements. Trends were evaluated using the autoregressive integrated moving average model. Two hundred sixteen (0.1%) trials were selected for further analysis. Academic centers (investigator initiated trials) were recorded as primary sponsors in 56.9% of trials, followed by industry 25.9%. Industry was the leading source of monetary support for the selected trials in 44.4%, followed by 25% of trials with primarily academic financial support. The number of newly initiated trials between 2005 and 2015 shows a positive trend, mainly through an increase in phase II trials, whereas phase III trials show a negative trend. The vast majority of trials evaluate forms of different systemic treatments (91.2%). In total, one hundred different molecular entities or biologicals were identified. Of those, 60% were involving drugs specifically designed for central nervous system malignancies. Trials that specifically address radiotherapy, surgery, imaging and other therapeutic or diagnostic methods appear to be rare. Current research in glioblastoma is mainly driven or sponsored by industry, academic medical oncologists and neuro-oncologists, with the majority of trials evaluating forms of systemic therapies. Few trials reach phase III. Imaging, radiation therapy and surgical procedures are underrepresented in current trials portfolios. Optimization in research portfolio for glioblastoma is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-016-0740-5) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Current status and perspectives of interventional clinical trials for glioblastoma – analysis of ClinicalTrials.gov

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Because histopathological analysis reveals diffuse tumor spread, critics argue that spatially targeted treatments like SRS are sub-optimal. However, most patients progress within a few centimeters of the primary tumor site, 4,35–39 so SRS might be sufficient for focal recurrences. One SRS modality, Gamma Knife (GK) (Elekta, Stockholm, Sweden), has seen diverse utilization for glioblastoma including as monotherapy, in combination with chemotherapy (eg, 40 ), for newly diagnosed disease (eg, 41 ) and for recurrence.…”

mentioning

confidence: 99%

Indications and Efficacy of Gamma Knife Stereotactic Radiosurgery for Recurrent Glioblastoma: 2 Decades of Institutional Experience

Imber

Kanungo²,

Braunstein

et al. 2016

NEUROSURGERY

View full text Add to dashboard Cite

Background The role of stereotactic radiosurgery (SRS) for recurrent glioblastoma and the radionecrosis risk in this setting remain unclear. Objective To perform a large retrospective study to help inform proper indications, efficacy, and anticipated complications of SRS for recurrent glioblastoma. Methods We retrospectively analyzed patients who underwent Gamma Knife SRS between 1991 and 2013. We used the partitioning deletion/substitution/addition (partDSA) algorithm to identify potential predictor covariate cut points and Kaplan-Meier and proportional hazards modeling to identify factors associated with post-SRS and post-diagnosis survival. Results 174 glioblastoma patients (median age 54.1 years) underwent SRS a median of 8.7 months after initial diagnosis. Seventy-five percent had one treatment target (range = 1–6) and median target volume, and prescriptions were 7.0 cm3 (range 0.3–39.0) and 16.0 Gy (range 10–22), respectively. Median overall survival was 10.6 months following SRS and 19.1 months after diagnosis. Kaplan-Meier and multivariable modeling revealed that younger age at SRS, higher prescription dose, and longer interval between original surgery and SRS are significantly associated with improved post-SRS survival. Forty-six patients (26%) underwent salvage craniotomy after SRS, with 63% showing radionecrosis or mixed tumor/necrosis versus 35% showing purely recurrent tumor. The necrosis/mixed group had lower mean isodose prescription compared to the tumor group (16.2 vs 17.8 Gy, P = .0031) and larger mean treatment volume (10.0 vs 5.4 cm3, P = .0091). Conclusion Gamma Knife may benefit a subset of focally recurrent patients, particularly those who are younger with smaller recurrences. Higher prescriptions are associated with improved post-SRS survival and do not seem to have greater risk of symptomatic treatment effect.

show abstract

“…These technologies allowed radiation oncologists to maintain maximal tumor coverage while significantly reducing the dose to normal tissues. Contemporary RT treatment volumes continue to evolve and attempts to further reduce RT margins are ongoing [24].…”

Section: Surgerymentioning

confidence: 99%

Success and Failures of Combined Modalities in Glioblastoma Multiforme: Old Problems and New Directions

Corso

Bindra

2016

Seminars in Radiation Oncology

View full text Add to dashboard Cite

Patterns of failure for glioblastoma multiforme following limited-margin radiation and concurrent temozolomide

Cited by 124 publications

References 18 publications

Current status and perspectives of interventional clinical trials for glioblastoma – analysis of ClinicalTrials.gov

Current status and perspectives of interventional clinical trials for glioblastoma – analysis of ClinicalTrials.gov

Indications and Efficacy of Gamma Knife Stereotactic Radiosurgery for Recurrent Glioblastoma: 2 Decades of Institutional Experience

Success and Failures of Combined Modalities in Glioblastoma Multiforme: Old Problems and New Directions

Contact Info

Product

Resources

About