Radiation Therapy of Glioblastoma

Barani, Igor J.; Larson, David A.

doi:10.1007/978-3-319-12048-5_4

Cited by 99 publications

(70 citation statements)

References 98 publications

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“…IFRT delivers external beam RT to the tumor with a 2–3 cm margin, which is based on the observation that, following RT, GBM recurs within 2 cm of the original tumor site in 80%–90% of cases (Narayana et al, 2006). Multiple studies in the early 1970s confirmed that IFRT had similar or slightly improved survival advantage over WBRT, with less normal tissue damage within the RT field (Barani & Larson, 2015). …”

Section: Treatmentmentioning

confidence: 99%

“…The typical total dose delivered is 60 Gy, in 1.8–2 Gy fractions administered five days per week for six weeks. A clear survival advantage has been demonstrated with postoperative RT doses to 60 Gy, but dose escalation beyond this has resulted in increased toxicity without additional survival benefits (Barani & Larson, 2015). …”

Section: Treatmentmentioning

confidence: 99%

“…To improve local control and limit toxicity to normal brain tissue, other techniques have been investigated, including iodine-125 brachytherapy, radioimmunotherapy, stereotactic radiosurgery, and hyperfractionation; however, these have not resulted in a significant survival advantage for newly diagnosed patients (Barani & Larson, 2015). …”

Section: Treatmentmentioning

confidence: 99%

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Glioblastoma: Overview of Disease and Treatment

Davis¹

2016

CJON

956

711

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Background Glioblastoma (GBM) is the most common and aggressive malignant brain tumor in adults. Current treatment options at diagnosis are multimodal and include surgical resection, radiation, and chemotherapy. Significant advances in the understanding of the molecular pathology of GBM and associated cell signaling pathways have opened opportunities for new therapies for recurrent and newly diagnosed disease. Innovative treatments, such as tumor-treating fields (TTFields) and immunotherapy, give hope for enhanced survival. Objectives This article reviews the background, risks, common complications, and treatment options for GBM. Methods A brief review of GBM, treatment options, and a look at new therapies that have been approved for new and recurrent disease are included in this article. Findings Despite aggressive resection and combined modality adjuvant treatment, most GBMs recur. Treatments, such as TTFields, drugs to target molecular receptors, and immunotherapy, are promising new options.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Glioblastoma: Overview of Disease and Treatment

Davis¹

2016

CJON

956

711

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“…Involved field fractionated radiotherapy doubled the overall survival from 6 to 12 months, and became next to surgery a cornerstone of the current standard of care [10]. Many trials focusing on doseescalation, hypo-or hyperfractionation, as well as radiosensitization or delivery of radiation as brachytherapy have not improved survival [12]. Although alkylating chemotherapy has been used for several decades, there was no significant improvement in overall survival until the introduction of temozolomide, which resulted in a 2.5-month increase in median survival [13].…”

Section: Introductionmentioning

confidence: 98%

How Treatment Monitoring Is Influencing Treatment Decisions in Glioblastomas

Neagu

Huang

Reardon

et al. 2015

Curr Treat Options Neurol

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Glioblastoma (GBM), the most common malignant primary tumor in adults, carries a dismal prognosis with an average median survival of 14-16 months. The current standard of care for newly diagnosed GBM consists of maximal safe resection followed by fractionated radiotherapy combined with concurrent temozolomide and 6 to 12 cycles of adjuvant temozolomide. The determination of treatment response and clinical decision-making in the treatment of GBM depends on accurate radiographic assessment. Differentiating treatment response from tumor progression is challenging and combines long-term follow-up using standard MRI, with assessing clinical status and corticosteroid dependency. At progression, bevacizumab is the mainstay of treatment. Incorporation of antiangiogenic therapies leads to rapid blood-brain barrier normalization with remarkable radiographic response often not accompanied by the expected survival benefit, further complicating imaging assessment. Improved radiographic interpretation criteria, such as the Response Assessment in Neuro-Oncology (RANO) criteria, incorporate non-enhancing disease but still fall short of definitely distinguishing tumor progression, pseudoresponse, and pseudoprogression. With new evolving treatment modalities for this devastating disease, advanced imaging modalities are increasingly becoming part of routine clinical care in a field where neuroimaging has such essential role in guiding treatment decisions and defining clinical trial eligibility and efficacy.

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“…It should be noted that dose-escalation attempts with photons beyond 60 Gy have resulted in increased toxicity but no additional survival benefit. 87 In a Phase II trial, the conventional 55-65 Gy photons dose was escalated to 90 Gy-E with a combination of protons and photons in accelerated fractionation. 88 The treatment led to a central tumour control in most cases, but tumours recurred in the periphery, and median survival time was 20 months.…”

Section: Particle Therapymentioning

confidence: 99%

Glioblastoma multiforme: emerging treatments and stratification markers beyond new drugs

Neubeck¹,

Seidlitz²,

Kitzler³

et al. 2015

BJR

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Glioblastoma multiforme (GBM) is the most common primary brain tumour in adults. The standard therapy for GBM is maximal surgical resection followed by radiotherapy with concurrent and adjuvant temozolomide (TMZ). In spite of the extensive treatment, the disease is associated with poor clinical outcome. Further intensification of the standard treatment is limited by the infiltrating growth of the GBM in normal brain areas, the expected neurological toxicities with radiation doses .60 Gy and the dose-limiting toxicities induced by systemic therapy. To improve the outcome of patients with GBM, alternative treatment modalities which add low or no additional toxicities to the standard treatment are needed. Many Phase II trials on new chemotherapeutics or targeted drugs have indicated potential efficacy but failed to improve the overall or progression-free survival in Phase III clinical trials. In this review, we will discuss contemporary issues related to recent technical developments and new metabolic strategies for patients with GBM including MR (spectroscopy) imaging, (amino acid) positron emission tomography (PET), amino acid PET, surgery, radiogenomics, particle therapy, radioimmunotherapy and diets.

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Radiation Therapy of Glioblastoma

Cited by 99 publications

References 98 publications

Glioblastoma: Overview of Disease and Treatment

Glioblastoma: Overview of Disease and Treatment

How Treatment Monitoring Is Influencing Treatment Decisions in Glioblastomas

Glioblastoma multiforme: emerging treatments and stratification markers beyond new drugs

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