Phase II Trial of Hypofractionated IMRT With Temozolomide for Patients With Newly Diagnosed Glioblastoma Multiforme

Reddy, Krishna; Damek, Denise; Gaspar, Laurie E.; Ney, Douglas; Waziri, Allen; Lillehei, Kevin O.; Stuhr, Kelly; Kavanagh, Brian D.; Chen, Changhu

doi:10.1016/j.ijrobp.2012.01.035

Cited by 63 publications

(37 citation statements)

References 19 publications

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“…For this reason, it is necessary to study further the alternative fraction protocols in patients with GBM. The results of dose escalation have been reported in small, single institution, phase I-II studies (14,15). In these studies, the overall survival has been reported as 20.1 months in patients treated with hypofractioned IMRT.…”

Section: Resultsmentioning

confidence: 99%

The Helical Tomotherapy Experience on Radiotherapy of Glioblastoma Multiforme

Küçüktülü¹

2018

Akd Med J

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Objective: The standard treatment of Glioblastome Multiforme (GBM) is surgical resection followed by chemoradiotherapy and adjuvant temozolamide. Intensity Modulated Radiotherapy (IMRT) offer an advantage in terms of reducing the dose to critical normal structures and a reduced dose to the normal brain. It also offers application of Simultaneous Integrated Boost (SIB). Material and Methods:Among our 12 patients, 7 had a diagnosis of GBM whereas 3 of them were anaplastic oligoastrocytoma and 2 of them were diagnosed radiologically as high-grade glial tumor. In all patients, 60 Gy SIB-IMRT with concomitant Temozolomide was used. Results:In post treatment Magnetic Resonance Imaging (MRI), 8 patients had no recurrence whereas 2 patients showed partial response and in 2 patients there was no response at all. After a median follow-up period of 12 months, 3 patients survived disease free, and 9 patients were expired. The overall survival was 14.8 months. Median progression free survival was 4.4 months. The mean dose received by the brain stem was 12.90 Gy and 12.72 Gy for the optic chiasm. Conclusion:High doses can be given while protecting critical tissues with SIB-IMRT.

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Section: Resultsmentioning

confidence: 99%

The Helical Tomotherapy Experience on Radiotherapy of Glioblastoma Multiforme

Küçüktülü¹

2018

Akd Med J

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“…Combined with the improvements in tumour delineation with MRI and PET imaging, IMRT now allows the potential for alteration to standard dose fractionation regimens with smaller better defined target volumes. This principally allows the dose escalation to be delivered via an integrated boost technique without extending the radiation treatment duration [11,15,16]; or via hypofractionation with a high dose of RT to a smaller target over shorter treatment duration [17,18]. Both of these approaches have potential radiobiological advantages, especially in tumours with a high proliferative rate.…”

Section: Discussionmentioning

confidence: 99%

“…This higher dose per fraction may increase the risk of late morbidity, but is minimized through the reduction in volume expansion. An example is a regimen of 60 Gy being delivered in 10 fractions over 2 weeks to a highly defined volume with a lower dose of 30 Gy to surrounding tissues [17]. The IMRT dose delivery is thus accelerated to the limited volume which may be defined by MRI, or PET tracers such as C-methionine.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Improvements Utilising Intensity Modulated Radiation Therapy for Patients with Glioblastoma Multiforme

Back¹,

Clifford²,

Wheeler³

et al. 2013

JCT

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Aims: The EORTC-NCI study investigating the addition of temozolomide trial to standard radiation therapy has demonstrated improved duration of survival in patients with Glioblastoma multiforme (GBM). With longer survival duration, there is the potential for latent RT morbidity, not previously seen in historical patients. This study evaluates the potential dosimetric advantages of utilising IMRT over 3D-conformal RT in such patients. Methods: 10 consecutive patients with GBM formally screened for a clinical study over a two-month period were planned and treated with IMRT utilising daily on-board imaging (OBI). The EORTC protocol dosimetric criteria and constraints were used in target delineation and planning. For each patient, a 3DCRT plan was also produced. Endpoints for dosimetric evaluation analysed related to tumour dose: mean PTV60 dose (mPTV60Dose), Conformity Index (CI); and normal tissue dose: mean normal brain dose (mBrainDose) and V40 Brain (Brainv40). IGRT endpoints were the median isocentre shifts required in 3 axes measured in one direction. The variation between the IMRT and 3DCRT dosimetric endpoints was examined using Wilcoxon analysis. Results: The 10 patients had tumours located in temporal (3), parietal (3), occipital (2) and callosal (2) regions. The median PTV and normal brain volumes were 308.1 cm 3 and 1077.5 cm 3 respectively. The IMRT dosimetry was significantly improved in all endpoints specifically CI (p = 0.002), mPTV60Dose (p = 0.004), mBrainDose (p = 0.002) and Brainv40 (p = 0.019). OBI directed isocentre measurements in the patient group were available for 230 treatments. The median shifts (and 95% C.I.s) were 0.1 cm vertical (0.1 -0.2), 0.1 cm longitudinal (0.1 -0.2) and 0.2 cm lateral (0.2 -0.2). At a minimum follow-up of 2 years' post diagnosis, the median survival of the group is 18.0 months (95% CI: 13.4 -22.6 months). Conclusion: IMRT for GBM produces significant dosimetric advantages in relation to planning target volume and normal tissue dose compared with 3D conformal plans. The data also confirm the accuracy of IMRT technique for CNS with IGRT delivery utilising OBI demonstrating minimal deviation from planned to treated isocentre.

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“…However, there may be a risk of enhanced radioresistance. Hypofractionated radiation has become a frequent choice in the treatment of GBM and DIPG patients [23][24][25][26][27].…”

Section: Radiotherapy Servicesmentioning

confidence: 99%

Pediatric Neuro-Oncology in Low-/Middle-Income Countries

Zaghloul¹

2016

Neurooncology - Newer Developments

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Pediatric cancer is becoming increasingly important in low-/middle-income countries (LMICs), due to the improvement in controlling communicable diseases, decrease infant, and early childhood mortalities associated with infection and malnutrition.Worldwide, although much improvement was encountered in many pediatric tumors particularly acute leukemia that represents the commonest type of cancer in children, this was not so obvious in CNS tumors, the second most common tumor type. Slow advances have been achieved to improve treatment end results in pediatric neuro-oncology. This was largely related to disease under diagnosis, incorrect clinical assessment, improper staging, and lack of the availability of appropriate radiologic, neurosurgical, and radiotherapeutic services in LMICs. Moreover, the need for multidisciplinary team working together to embalmment unified approved management guidelines, highly specific care level within a widely accepted quality control measures are of utmost importance to raise the treatment outcome levels to that of high-income countries (HICs).Much effort is needed in LMICs to improve the management of pediatric CNS tumors, decrease the gap, and reach good results already attained by the dedicated centers in HICs. There are many international organizations and societies that can and are willing to help in this matter.In this chapter, an illustration of the obstacles faced by LMIC neuro-oncologists will be discussed. The different ways and procedures are recommended to improve the general situation to attain good results similar to that in HICs.

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Phase II Trial of Hypofractionated IMRT With Temozolomide for Patients With Newly Diagnosed Glioblastoma Multiforme

Cited by 63 publications

References 19 publications

The Helical Tomotherapy Experience on Radiotherapy of Glioblastoma Multiforme

The Helical Tomotherapy Experience on Radiotherapy of Glioblastoma Multiforme

Dosimetric Improvements Utilising Intensity Modulated Radiation Therapy for Patients with Glioblastoma Multiforme

Pediatric Neuro-Oncology in Low-/Middle-Income Countries

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