Radiosurgery as part of the initial management of patients with malignant gliomas.

Loeffler, Jay S.; Alexander, Eben; Shea, William M.; Wen, Patrick Y.; Fine, Howard A.; Kooy, Hanne M.; Black, Peter McL.

doi:10.1200/jco.1992.10.9.1379

Cited by 237 publications

(78 citation statements)

References 15 publications

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“…Further dose intensification through higher radiation doses and altered fractionation was pursued, but failed to provide a clear clinical benefit. ( 9 , 10 ) Currently, 60 Gy remains the standard dose for high‐grade glioma. However, with advances in diagnostic imaging and radiotherapy techniques, the role of radiation dose intensification in the management of high‐grade glioma is likely to undergo further exploration.…”

Section: Introductionmentioning

confidence: 99%

Intensity modulated radiation therapy versus three‐dimensional conformal radiation therapy for the treatment of high grade glioma: a dosimetric comparison

MacDonald

Ahmad

Kachris

et al. 2007

J Applied Clin Med Phys

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The present study compared the dosimetry of intensity‐modulated radiation therapy (IMRT) and three‐dimensional conformal radiation therapy (3D‐CRT) techniques in patients treated for high‐grade glioma. A total of 20 patients underwent computed tomography treatment planning in conjunction with magnetic resonance imaging fusion. Prescription dose and normal‐tissue constraints were identical for the 3D‐CRT and IMRT plans. The prescribed dose was 59.4 Gy delivered at 1.8 Gy per fraction using 4 – 10 MV photons. Normal‐tissue dose constraints were 50 – 54 Gy for the optic chiasm and nerves, and 55 – 60 Gy for the brainstem.The IMRT plan yielded superior target coverage as compared with the 3D‐CRT plan. Specifically, minimum and mean planning target volume cone down doses were 54.52 Gy and 61.74 Gy for IMRT and 50.56 Gy and 60.06 Gy for 3D‐CRT (p≤0.01). The IMRT plan reduced the percent volume of brainstem receiving a dose greater than 45 Gy by 31% (p=0.004) and the percent volume of brain receiving a dose greater than 18 Gy, 24 Gy, and 45 Gy by 10% (p=0.059), 14% (p=0.015), and 40% (p≤0.0001) respectively. With IMRT, the percent volume of optic chiasm receiving more than 45 Gy was also reduced by 30.40% (p=0.047). As compared with 3D‐CRT, IMRT significantly increased the tumor control probability (p≤0.005) and lowered the normal‐tissue complication probability for brain and brainstem (p<0.033).Intensity‐modulated radiation therapy improved target coverage and reduced radiation dose to the brain, brainstem, and optic chiasm. With the availability of new cancer imaging tools and more effective systemic agents, IMRT may be used to intensify tumor doses while minimizing toxicity, therefore potentially improving outcomes in patients with high‐grade glioma.PACs number: 87.53 Tf

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Section: Introductionmentioning

confidence: 99%

Intensity modulated radiation therapy versus three‐dimensional conformal radiation therapy for the treatment of high grade glioma: a dosimetric comparison

MacDonald

Ahmad

Kachris

et al. 2007

J Applied Clin Med Phys

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“…The rapid doubling time inherent to GBM likely contributes to the ability of these tumors to repopulate in a short time. Indeed, it has been noted that approximately 19% of patients may have clinically progressed while undergoing conventionally fractionated radiation therapy [36].…”

Section: Discussionmentioning

confidence: 99%

Innovative Hypofractionated Stereotactic Regimen Achieves Excellent Local Control With No Radiation Necrosis: Promising Results in the Management of Patients With Small Recurrent Inoperable GBM

Jia

Pannullo

Schwartz

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…Tumors are targeted by the application of a tightly focused high-energy radiation field with minimal collateral damage to the surrounding normal tissue. 15,16 Unfortunately, glioma tumor cells often invade normal brain tissue surrounding the tumor and migrate along normal white matter tracts. This feature of glioma is largely responsible for the ineffectiveness of surgical tumor resection.…”

Section: Introductionmentioning

confidence: 99%

Safety and biodistribution studies of an HSV multigene vector following intracranial delivery to non-human primates

et al. 2004

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Malignant glioma is a fatal human cancer in which surgery, chemo-and radiation therapies are ineffective. Therapeutic gene transfer used in combination with current treatment methods may augment their effectiveness with improved clinical outcome. We have shown that NUREL-C2, a replication-defective multigene HSV-based vector, is effective in treating animal models of glioma. Here, we report safety and biodistribution studies of NUREL-C2 using rhesus macaques as a model host. Increasing total doses (1 Â 10 7 to 1 Â 10 9 plaque forming units (PFU)) of NUREL-C2 were delivered into the cortex with concomitant delivery of ganciclovir (GCV). The animals were evaluated for changes in behavior, alterations in blood cell counts and chemistry. The results showed that animal behavior was generally unchanged, although the chronic intermediate dose animal became slightly ataxic on day 12 postinjection, a condition resolved by treatment with aspirin. The blood chemistries were unremarkable for all doses. At 4 days following vector injections, magnetic resonance imaging showed inflammatory changes at sites of vector injections concomitant with HSV-TK and TNFa expression. The inflammatory response was reduced at 14 days, resolving by 1 month postinjection, a time point when transgene expression also became undetectable. Immunohistochemical staining following animal killing showed the presence of a diffuse low-grade gliosis with infiltrating macrophages localized to the injection site, which also resolved by 1 month postinoculation. Viral antigens were not detected and injected animals did not develop HSV-neutralizing antibodies. Biodistribution studies revealed that vector genomes remained at the site of injection and were not detected in other tissues including contralateral brain. We concluded that intracranial delivery of 1 Â 10 9 PFU NUREL-C2, the highest anticipated patient dose, was well tolerated and should be suitable for safety testing in humans.

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Radiosurgery as part of the initial management of patients with malignant gliomas.

Abstract: We conclude that radiosurgery is a useful adjunct to other modalities in the initial management of patients with small, radiographically well-defined malignant gliomas.

Cited by 237 publications

References 15 publications

Intensity modulated radiation therapy versus three‐dimensional conformal radiation therapy for the treatment of high grade glioma: a dosimetric comparison

Intensity modulated radiation therapy versus three‐dimensional conformal radiation therapy for the treatment of high grade glioma: a dosimetric comparison

Innovative Hypofractionated Stereotactic Regimen Achieves Excellent Local Control With No Radiation Necrosis: Promising Results in the Management of Patients With Small Recurrent Inoperable GBM

Safety and biodistribution studies of an HSV multigene vector following intracranial delivery to non-human primates

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