Radiation therapy for glioblastoma: Executive summary of an American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline

Cabrera, Alvin R.; Kirkpatrick, John P.; Fiveash, John B.; Shih, Helen A.; Koay, Eugene J.; Lutz, S; Petit, Joshua H.; Chao, Samuel T.; Brown, Paul D.; Vogelbaum, Michael A.; Reardon, David A.; Chakravarti, Arnab; Wen, Patrick Y.; Chang, Eric L.

doi:10.1016/j.prro.2016.03.007

Cited by 185 publications

(154 citation statements)

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“…At this time, given the heterogeneity of patient and treatment characteristics and lack of phase III data, there is insufficient evidence to support one treatment scheme over any other. 111 Given that recurrent GBM often has indistinct borders, a problem compounded by the fact that these lesions typically appear within previously irradiated fields, novel imaging techniques, such as the use of MR-based apparent diffusion coefficient mapping, may prove useful in improving target delineation. 112 …”

Section: Recurrent Gbmmentioning

confidence: 99%

The radiosurgery fractionation quandary: single fraction or hypofractionation?

et al. 2017

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Stereotactic radiosurgery (SRS), typically administered in a single session, is widely employed to safely, efficiently, and effectively treat small intracranial lesions. However, for large lesions or those in close proximity to critical structures, it can be difficult to obtain an acceptable balance of tumor control while avoiding damage to normal tissue when single-fraction SRS is utilized. Treating a lesion in 2 to 5 fractions of SRS (termed "hypofractionated SRS" [HF-SRS]) potentially provides the ability to treat a lesion with a total dose of radiation that provides both adequate tumor control and acceptable toxicity. Indeed, studies of HF-SRS in large brain metastases, vestibular schwannomas, meningiomas, and gliomas suggest that a superior balance of tumor control and toxicity is observed compared with single-fraction SRS. Nonetheless, a great deal of effort remains to understand radiobiologic mechanisms for HF-SRS driving the dose-volume response relationship for tumors and normal tissues and to utilize this fundamental knowledge and the results of clinic studies to optimize HF-SRS. In particular, the application of HF-SRS in the setting of immunomodulatory cancer therapies offers special challenges and opportunities. Key wordsbrain metastases | hypofractionated stereotactic radiosurgery | normal tissue injury | radiobiology | stereotactic radiosurgery ii39 Kirkpatrick et al. Hypofractionated SRS

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Section: Recurrent Gbmmentioning

confidence: 99%

The radiosurgery fractionation quandary: single fraction or hypofractionation?

et al. 2017

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“…On review of among others recently reported ASTRO [7] and ESTRO-ACROP guidelines for glioblastomas [8], it would appear that substantial innovations with respect to radiotherapy approaches such as target definition, fractionation and planning as well as delivery techniques are largely lacking, or at least these innovations do not appear to find their way to current guidelines. From this unsubstantiated observation, the question arises whether these components of modern radiotherapy have been an integral part of past or current trials performed in glioblastoma patients.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…For a newly diagnosed GBM, a maximum safe surgical resection followed by combined radiation therapy and chemotherapy with temozolomide (TMZ) is the current standard of care. Radiation suppresses the growth of GBM and prolongs the survival of patients with GBM, and, therefore, it is central to the treatment of GBM . Radiosensitization by arresting the cell cycle in M‐phase has been shown to increase the efficacy of radiation.…”

Section: Introductionmentioning

confidence: 99%

Concomitant administration of radiation with eribulin improves the survival of mice harboring intracerebral glioblastoma

Miki

Imamichi²,

Fujimori³

et al. 2018

Cancer Science

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Glioblastoma is the most common and devastating type of malignant brain tumor. We recently found that eribulin suppresses glioma growth in vitro and in vivo and that eribulin is efficiently transferred into mouse brain tumors at a high concentration. Eribulin is a non‐taxane microtubule inhibitor approved for breast cancer and liposarcoma. Cells arrested in M‐phase by chemotherapeutic agents such as microtubule inhibitors are highly sensitive to radiation‐induced DNA damage. Several recent case reports have demonstrated the clinical benefits of eribulin combined with radiation therapy for metastatic brain tumors. In this study, we investigated the efficacy of a combined eribulin and radiation treatment on human glioblastoma cells. The glioblastoma cell lines U87MG, U251MG and U118MG, and SJ28 cells, a patient‐derived sphere culture cell line, were used to determine the radiosensitizing effect of eribulin using western blotting, flow cytometry and clonogenic assay. Subcutaneous and intracerebral glioma xenografts were generated in mice to assess the efficacy of the combined treatment. The combination of eribulin and radiation enhanced DNA damage in vitro. The clonogenic assay of U87MG demonstrated the radiosensitizing effect of eribulin. The concomitant eribulin and radiation treatment significantly prolonged the survival of mice harboring intracerebral glioma xenografts compared with eribulin or radiation alone (P < .0001). In addition, maintenance administration of eribulin after the concomitant treatment further controlled brain tumor growth. Aberrant microvasculature was decreased in these tumors. Concomitant treatment with eribulin and radiation followed by maintenance administration of eribulin may serve as a novel therapeutic strategy for glioblastomas.

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Radiation therapy for glioblastoma: Executive summary of an American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline

Abstract: Radiation therapy occupies an integral role in treating glioblastoma. Whether and how radiation therapy should be applied depends on characteristics specific to tumor and patient, including age and performance status.

Cited by 185 publications

References 43 publications

The radiosurgery fractionation quandary: single fraction or hypofractionation?

The radiosurgery fractionation quandary: single fraction or hypofractionation?

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

Concomitant administration of radiation with eribulin improves the survival of mice harboring intracerebral glioblastoma

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