Hypofractionated intensity-modulated radiotherapy using simultaneous integrated boost technique with concurrent and adjuvant temozolomide for glioblastoma.

Abstract

AIMS AND BACKGROUND:

We assessed the therapeutic efficacy of combined hypofractionated intensity-modulated radiotherapy with temozolomide in patients with primary glioblastoma.

METHODS AND STUDY DESIGN:

Thirty-nine patients with histologically confirmed glioblastoma were accrued. Using the simultaneous integrated boost technique, a dose of 50 Gy in 5-Gy fractions was applied to the gross tumor volume, together with 40 Gy in 4-Gy fractions and 30 Gy in 3-Gy fractions to the 1- and 2-cm margins from the gross tumor volume, respectively. Patients were also treated with concurrent temozolomide during intensity-modulated radiotherapy, followed by six cycles of adjuvant temozolomide.

RESULTS:

Median follow-up was 16.8 months (range, 4.3-54.3). Tumor progression was observed in 28 patients (71.8%), and the median time to progression was 6.8 months. Median survival was 16.8 months, and it was affected significantly by the extent of surgery. During adjuvant temozolomide treatment, 3 patients (9.7%) developed grade 3-4 hematologic or hepatic toxicity. Radiation necrosis developed in 7 patients (17.9%) and massive necrosis, requiring emergency surgery, in 1 patient (2.6%).

CONCLUSIONS:

The regimen of hypofractionated intensity-modulated radiotherapy with temozolomide showed a relatively good outcome in patients with glioblastoma. Further studies are required to define the optimal fraction size for glioblastoma using this highly sophisticated radiation technique.

• Authors: Sang Min Yoon, Jeong Hoon Kim, Sang Joon Kim, Shin Kwang Khang, Seong Soo Shin, Young Hyun Cho, Eunjin Jwa, Jin-Hong Park, Seung Do Ahn
• Journal: Tumori (Tumori) 2013 Jul-Aug Vol. 99 Issue 4 Pg. 480-7 ISSN: 2038-2529 [Electronic] United States
• PMID: 24326836 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents, Alkylating
• Dacarbazine
• Temozolomide

Topics

• Adult
• Aged
• Antineoplastic Agents, Alkylating (administration & dosage, adverse effects, therapeutic use)
• Brain (pathology, radiation effects)
• Brain Neoplasms (pathology, therapy)
• Chemoradiotherapy, Adjuvant
• Chemotherapy, Adjuvant
• Dacarbazine (administration & dosage, adverse effects, analogs & derivatives, therapeutic use)
• Disease-Free Survival
• Dose Fractionation, Radiation
• Female
• Glioblastoma (pathology, therapy)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Necrosis (etiology)
• Radiotherapy, Intensity-Modulated
• Temozolomide
• Treatment Failure
• Treatment Outcome