Hostname: page-component-745bb68f8f-l4dxg Total loading time: 0 Render date: 2025-02-02T06:05:18.977Z Has data issue: false hasContentIssue false
  • English
  • Français

Radiosurgery and Accelerated Radiotherapy for Patients with Glioblastoma

Published online by Cambridge University Press:  18 September 2015

G. Shenouda ,
L. Souhami ,
E.B. Podgorsak ,
J.P Bahary ,
J.G. . Villemure ,
J.L. Caron  and
G. Mohr
G. Shenouda*
Affiliation:
Departments of Radiation Oncology McGill University, Montreal,
L. Souhami
Affiliation:
Departments of Radiation Oncology McGill University, Montreal,
E.B. Podgorsak
Affiliation:
Departments of Radiation Oncology McGill University, Montreal,
J.P Bahary
Affiliation:
Departments of Radiation Oncology McGill University, Montreal,
J.G. . Villemure
Affiliation:
Neurosurgery McGill University, Montreal,
J.L. Caron
Affiliation:
Neurosurgery McGill University, Montreal,
G. Mohr
Affiliation:
Neurosurgery McGill University, Montreal,
*
Radiation Oncology Department, Sir Mortimer B. Davis - Jewish General Hospital, 3755 Chemin de la Côte St. Catherine, Montréal, Québec, Canada H3T 1E2 110
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

To assess the feasibility, toxicity, and local control of stereotactic radiosurgery followed by accelerated external beam radiotherapy (AEBR) for patients with glioblastoma multiforme.

Materials and methods:

Six males and eight females, with a median age of 67.5 years (range 45-78 years), entered the study. Karnofsky performance status was 90 for five, 80 for six, and 60 for three patients. Following surgery, the patients were left with a residual mass 4 cm. Radiosurgery was delivered with a single dose of 20 Gy to the 90% isodose surface corresponding to the contrast-enhancing edge of the tumour. A total AEBR dose of 60 Gy in 30 fractions was delivered using a concomitant boost technique over four weeks.

Results:

Median survival time was 40 weeks (range 17-80 weeks). Actuarial survivals at 12 and 18 months were 43% and 14%, respectively. The median time to progression was 25 weeks (range 2-77 weeks). One patient developed a seizure on the day of stereotactic radiosurgery. Two patients experienced somnolence at 47 and 67 days post-radiotherapy. Eight patients remained steroid-dependent. Radiological evidence of leukoencephalopathy was observed in one patient, and brain necrosis in two additional patients at 30 and 63 weeks. One of these two patients with brain necrosis developed complete loss of vision in one eye, and decreased vision in the contralateral eye at 63 weeks.

Conclusion:

Stereotactic radiosurgery followed by AEBR was feasible but was associated with late complications. The use of such radiosurgical boost for patients with glioblastoma multiforme should be reserved for those patients entering controlled clinical trials.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 24 , Issue 2 , May 1997 , pp. 110 - 115
Copyright
Copyright © Canadian Neurological Sciences Federation 199

References

REFERENCES

1.Hochberg, FH, Pruitt, A. Assumptions in the radiotherapy of glioblastoma. Neurology 1980; 30 907–911.CrossRefGoogle ScholarPubMed
2.Green, SB, Byar, DP, Walker, MD, et al. Comparison of carmustine, procarbazine, and high dose methyl prednisolone as additions to surgery and radiotherapy for the treatment of malignant glioma. Cancer Treat Rep 1983; 67: 121–132.Google Scholar
3.Kristiansen, K, Hagen, S, Kollevoid, T, et al. Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: a prospective multicenter trial of the Scandinavian Glioblastoma Group. Cancer 1981; 47: 649–652.3.0.CO;2-W>CrossRefGoogle Scholar
4.Nelson, DF, Diener-West, M, Horton, J, et al. Combined modality approach to treatment of malignant gliomas-re-evaluation of RTOG 7401/ECOG 1374 with long-term follow-up: a joint study of the Radiation Oncology Group and the Eastern Cooperative Oncology Group. NCI Monogr 1988; 6: 279–284.Google Scholar
5.Salazar OM, Rubin, P, Feldstein, ML, Pizzutiello, R. High dose radiation therapy in the treatment of malignant gliomas: final report. Int J Radiat Oncol Biol Phys 1979; 5: 1733–1740.CrossRefGoogle Scholar
6.Walker, MD, Alexander, E Jr , Hunt, WE. et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas: a cooperative clinical trial. J Neurosurg 1978; 49: 333–343.CrossRefGoogle ScholarPubMed
7.Fowler, JF. How worthwhile are short schedules in radiotherapy?: a series of exploratory calculations. Radiother Oncol 1990; 18: 165–181.CrossRefGoogle ScholarPubMed
8.Fowler, JF. Intervals between multiple fractions per day – differences between late and early reactions. Acta Oncol 1988; 27: 181–183.CrossRefGoogle Scholar
9.Hoshino, T, Baker, M, Wilson, CB, Boldrey, EB, Fewer, D. Cell kinetics of human gliomas. J Neurosurg 1972; 37: 15–26.CrossRefGoogle ScholarPubMed
10.Hoshino, T, Wilson, CB. Cell kinetic analyses of human malignant brain tumours (gliomas). Cancer 1979; 44: 956–962.3.0.CO;2-C>CrossRefGoogle Scholar
11.Peschel, RE, Fisher, JJ. Multiple daily fractionation schedules. Int J Radiat Oncol Biol Phys 1982; 8: 1811–1812.CrossRefGoogle ScholarPubMed
12.Thames, HD, Peters, LJ, Withers, HR, Fletcher, GH. Accelerated fractionation versus hyperfractionation: rationales for several treatments per day. Int J Radiat Oncol Biol Phys 1983: 9: 127–138.CrossRefGoogle Scholar
13.Van Der Kogel, AJ. Radiation tolerance of the rat spinal cord: timedose relationships. Radiol 1977; 122: 505–509.CrossRefGoogle ScholarPubMed
14.Walker, MD, Strike, TA, Sheline, GE. An analysis of dose-effect relationship in radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys 1979: 5: 1725–1731.CrossRefGoogle ScholarPubMed
15.Withers, HR. Biologic basis for altered fractionation schemes. Cancer 1985; 55: 2086–2095.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
16.Keim, H, Potthoff, PC, Schmidt, K, et al. Survival and quality of life after continuous accelerated radiotherapy of glioblastomas. Radiother Oncol 1987; 9: 21–26.CrossRefGoogle ScholarPubMed
17.Shenouda, G, Souhami, L, Freeman, CR, et al. Accelerated fractionation for high grade cerebral astrocytomas: preliminary treatments results. Cancer 1991; 67: 2247–2252.3.0.CO;2-Q>CrossRefGoogle Scholar
18.Shin, KH, Urtasun, RC, Fulton, D, et al. Multiple daily fractionated radiation therapy and misonidazole in the management of malignant astrocytoma: a preliminary report. Cancer 1985; 56: 758–760.3.0.CO;2-2>CrossRefGoogle ScholarPubMed
19.Ang, K, Van Der Schueren, E, Notter, G, et al. Split course multiple daily fractionated radiotherapy schedule combined with misonidazole for the management of grade III and IV gliomas. Int J Radiat Oncol Biol Phys 1982; 8: 1657–1664.CrossRefGoogle ScholarPubMed
20.Bignardi, M, Bertoni, F. Radiation treatment with twice a day fractionation versus conventional fractionation in high grade astrocytomas: a retrospective study. Acta Oncologica 1987; 26: 441–445.CrossRefGoogle Scholar
21.Deutsch, M, Green, SB, Strike, TA, et al. Results of a randomized trial comparing BCNU plus radiotherapy, streptozotocin plus radiotherapy, BCNU plus hyperfractionated radiotherapy, and BCNU following misonidazole plus radiotherapy in the postoperative treatment of malignant glioma. Int J Radiat Oncol Biol Phys 1989; 16: 1389–1396.CrossRefGoogle ScholarPubMed
22.Nelson, DF, Schoenfeld, D, Weinstein, AS, et al. A randomized comparison of misonidazole sensitized radiotherapy plus BCNU and radiotherapy plus BCNU for treatment of malignant glioma after surgery: preliminary results of an RTOG study. Int J Radiat Oncol Biol Phys 1983; 9: 1143–1151.CrossRefGoogle ScholarPubMed
23.Nelson, DF, Curran, WJ, Scott, C, et al. Hyperfractionated radiation therapy and bis-chlorethyl nitrosourea in the treatment of malignant glioma – possible advantage observed at 72.0 Gy in 1.2 Gy b.i.d. fractions. Report of the Radiation Therapy Oncology Group protocol 8302. Int J Radiat Oncol Biol Phys 1993; 25: 193–207.CrossRefGoogle ScholarPubMed
24.Ludgate, CM, Douglas, BG, Dixon, DF, et al. Superfractionated radiotherapy in grade III, IV intracranial gliomas. Int J Radiat Oncol Biol Phys 1988; 15: 1091–1095.CrossRefGoogle ScholarPubMed
25.Shin, KH, Muller, PJ, Geggie, PH. Superfractionation radiation therapy in the treatment of malignant astrocytomas. Cancer 1983; 52: 2020–2043.3.0.CO;2-K>CrossRefGoogle Scholar
26.Gray, AJ.Treatment of advanced head and neck cancer with accelerated fractionation. Int J Radiat Oncol Biol Phys 1986; 12: 9–12.CrossRefGoogle ScholarPubMed
27.Wang, CC, Sult, HD, Blitzer, PH. Twice-a-day radiation therapy for supraglottic carcinoma. Int J Radiat Oncol Biol Phys 1986; 12: 3–7.CrossRefGoogle ScholarPubMed
28.Wallner, KE, Galicich, JH, Krol, G, Arbit, E, Malkin, MG.Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 1989; 16: 1405–1409.CrossRefGoogle ScholarPubMed
24.Souhami, L, Olivier, A, Podgorsak, E, et al. Radiosurgery of cerebral arteriovenous malformations with the dynamic stereotactic irradiation. Int J Radiat Oncol Biol Phys 1990; 19: 775–782.CrossRefGoogle ScholarPubMed
30.Steiner, L.Radiosurgery in cerebral arteriovenous malformations. In. Fein, J, Flamm, E, eds. Cerebrovascular Surgery. New York: Springer-Verlag, 1986; (4): 1161–1215.Google Scholar
31.Podgorsak, EB, Olivier, A, Pla, M, et al. Dynamic radiosurgery. Int J Radiat Oncol Biol Phys.1988; 14: 115–126.CrossRefGoogle Scholar
32.Pike, GB, Podgorsak, EB, Peters, TM, Pla, C.Dose distribution in dynamic stereotactic radiosurgery. Med Phys. 1987; 14: 780–789.CrossRefGoogle ScholarPubMed
33.Kaplan, EL, Meier, P. Nonparametric estimation for incomplete observations. J Am Stat Assoc. 1958; 53: 457–481.CrossRefGoogle Scholar
34.Mantel, N.Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1969; 50: 163–170.Google Scholar
35.Green, SB, Shapiro, WR, Burger, PC, et al. A randomized trial of interstitial radiotherapy boost for newly diagnosed malignant glioma. Brain Tumour Cooperative Group Trial 8701. Proc Am Soc Clin Oncol. 1994; 13: 174.Google Scholar
36.Scharfen, CO, Sneed, PK, Wara, WMet al. High activity iodine-125 implant for gliomas. Int J Radiat Oncol Biol Phys. 1992; 24: 583–591.CrossRefGoogle ScholarPubMed
37.Wen, PY, Alexander, E III , Black, PMet al. Long term results of stereotactic brachytherapy used in the initial treatment of patients with glioblastomas. Cancer. 1994; 73: 3029–3036.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
38.Florell, RC, MacDonald, DR, Irish, WDet al. Selection bias, survival and brachytherapy for glioma. J Neurosurg. 1992; 76: 179–183.CrossRefGoogle ScholarPubMed
39.Coffey, RJ, Lunsford, LD, Flickinger, JC. The role of radiosurgery in the treatment of malignant brain tumours. Neurosurg Clin North Am 1992; 3 (1): 231–244.CrossRefGoogle Scholar
40.Loeffler, JS, Siddon, RL, Wen, PYet al. Stereotactic radiosurgery of the brain using a standard linear accelerator: a study of late effects. Radiother Oncol. 1990; 17: 311–321.CrossRefGoogle ScholarPubMed
41.Mehta, MP, Masciopinto, J, Rozental, J, et al. Stereotactic radiosurgery for glioblastoma multiforme: report of a prospective study evaluating prognostic factors and analyzing long-term survival advantage. Int J Radiat Oncol Biol Phys. 1994; 30: 541–549.CrossRefGoogle ScholarPubMed
42.Buatti, JM, Friedman, WA, Bova, FJ, Mendenhall, WM. Linac radiosurgery for high-grade gliomas: the University of Florida Experience. Int J Radiat Oncol Biol Phys. (in press).Google Scholar
43.Gannett, D, Stea, B, Lulu, B, et al. Stereotactic radiosurgery as an adjunct to surgery and external beam radiotherapy in the treatment of patients with malignant gliomas. Int J Radiat Oncol Biol Phys. 1995; 33: 461–468.CrossRefGoogle ScholarPubMed
44.Curran, WJ, Scott, CB, Horton, J, et al. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst. 1993; 85: 704–710.CrossRefGoogle ScholarPubMed
45.Sarkaria, JN, Mehta, MP, Loeffler, JS, et al. Radiosurgery in the initial management of malignant gliomas: survival comparison with the RTOG recursive partitioning analysis. Int J Radiat Oncol Biol Phys. 1995; 32: 931–941.CrossRefGoogle ScholarPubMed
46.Chun, M, McKeough, P, Wu, A, et al. Interstitial iridium-192 implantation for malignant brain tumours. Br J Radiol. 1989; 62: 158–162.CrossRefGoogle ScholarPubMed
47.Curran, WJ, Scott, CB, Weinstein, AS. Survival comparison of radiosurgery-eligible and ineligible malignant glioma patients treated with hyperfractionated radiation therapy and carmustine. A report of Radiation Therapy Oncology Group 83–02. J Clin Oncol. 1993; 11: 857–862.CrossRefGoogle ScholarPubMed