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Hypofractionated Radiotherapy and Stereotactic Boost with Concurrent and Adjuvant Temozolamide for Glioblastoma in Good Performance Status Elderly Patients - Early Results of a Phase II Trial.

Floyd SR, Kasper EM, Uhlmann EJ, Fonkem E, Wong ET, Mahadevan A - Front Oncol (2012)

Bottom Line: The median progression free survival was 11 months and the median overall survival was 13 months.There was no additional toxicity.These results indicate that elderly patients with good KPS can achieve outcomes comparable to the current standard of care using an abbreviated radiotherapy course, radiosurgery boost, and temozolomide.

View Article: PubMed Central - PubMed

Affiliation: Beth Israel Deaconess Medical Center Boston, MA, USA ; Harvard Medical School Boston, MA, USA.

ABSTRACT
Glioblastoma Multiforme (GBM) is an aggressive primary brain neoplasm with dismal prognosis. Based on successful phase III trials, 60 Gy involved-field radiotherapy in 30 fractions over 6 weeks [Standard radiation therapy (RT)] with concurrent and adjuvant temozolomide is currently the standard of care. In this disease, age and Karnofsky Performance Status (KPS) are the most important prognostic factors. For elderly patients, clinical trials comparing standard RT with radiotherapy abbreviated to 40 Gy in 15 fractions over 3 weeks demonstrated similar outcomes, indicating shortened radiotherapy may be an appropriate option for elderly patients. However, these trials did not include temozolomide chemotherapy, and included patients with poor KPS, possibly obscuring benefits of more aggressive treatment for some elderly patients. We conducted a prospective Phase II trial to examine the efficacy of a hypofractionated radiation course followed by a stereotactic boost with concurrent and adjuvant temozolomide chemotherapy in elderly patients with good performance status. In this study, patients 65 years and older with a KPS > 70 and histologically confirmed GBM received 40 Gy in 15 fractions with 3D conformal technique followed by a 1-3 fraction stereotactic boost to the enhancing tumor. All patients also received concurrent and adjuvant temozolomide. Patients were evaluated 1 month post-treatment and every 2 months thereafter. Between 2007 and 2010, 20 patients (9 males and 11 females) were enrolled in this study. The median age was 75.4 years (range 65-87 years). At a median follow-up of 11 months (range 7-32 months), 12 patients progressed and 5 are alive. The median progression free survival was 11 months and the median overall survival was 13 months. There was no additional toxicity. These results indicate that elderly patients with good KPS can achieve outcomes comparable to the current standard of care using an abbreviated radiotherapy course, radiosurgery boost, and temozolomide.

No MeSH data available.


Related in: MedlinePlus

EBRT and CyberKnife SRS treatment plans for a patient who received 40 Gy in 15 fractions to FLAIR for the first course followed an SRS boost to T1 Enhancement at a total dose of 24 Gy delivered in 3 fractions. Shown are the (A) axial, (B) sagittal, and (C) coronal views of the EBRT treatment plans and the (D) axial, (E) sagittal, and (F) coronal views of the CyberKnife SRS treatment plans.
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Figure 1: EBRT and CyberKnife SRS treatment plans for a patient who received 40 Gy in 15 fractions to FLAIR for the first course followed an SRS boost to T1 Enhancement at a total dose of 24 Gy delivered in 3 fractions. Shown are the (A) axial, (B) sagittal, and (C) coronal views of the EBRT treatment plans and the (D) axial, (E) sagittal, and (F) coronal views of the CyberKnife SRS treatment plans.

Mentions: Twenty patients (9 male and 11 female patients) were included in this study. The mean age was 75.4 years (range 65–87 years). All patients completed the protocol treatment as prescribed. After delivery of 40 Gy in 15 fractions for the initial course, three patients received a single fraction SRS boost. The remaining 17 patients had a target volume exceeding 4 cm in greatest dimension. These patients received a total SRS boost dose of 24 Gy delivered in 3 fractions. Table 1 describes the patient and treatment characteristics. Figure 1 illustrates an EBRT and a SRS treatment plan.


Hypofractionated Radiotherapy and Stereotactic Boost with Concurrent and Adjuvant Temozolamide for Glioblastoma in Good Performance Status Elderly Patients - Early Results of a Phase II Trial.

Floyd SR, Kasper EM, Uhlmann EJ, Fonkem E, Wong ET, Mahadevan A - Front Oncol (2012)

EBRT and CyberKnife SRS treatment plans for a patient who received 40 Gy in 15 fractions to FLAIR for the first course followed an SRS boost to T1 Enhancement at a total dose of 24 Gy delivered in 3 fractions. Shown are the (A) axial, (B) sagittal, and (C) coronal views of the EBRT treatment plans and the (D) axial, (E) sagittal, and (F) coronal views of the CyberKnife SRS treatment plans.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472503&req=5

Figure 1: EBRT and CyberKnife SRS treatment plans for a patient who received 40 Gy in 15 fractions to FLAIR for the first course followed an SRS boost to T1 Enhancement at a total dose of 24 Gy delivered in 3 fractions. Shown are the (A) axial, (B) sagittal, and (C) coronal views of the EBRT treatment plans and the (D) axial, (E) sagittal, and (F) coronal views of the CyberKnife SRS treatment plans.
Mentions: Twenty patients (9 male and 11 female patients) were included in this study. The mean age was 75.4 years (range 65–87 years). All patients completed the protocol treatment as prescribed. After delivery of 40 Gy in 15 fractions for the initial course, three patients received a single fraction SRS boost. The remaining 17 patients had a target volume exceeding 4 cm in greatest dimension. These patients received a total SRS boost dose of 24 Gy delivered in 3 fractions. Table 1 describes the patient and treatment characteristics. Figure 1 illustrates an EBRT and a SRS treatment plan.

Bottom Line: The median progression free survival was 11 months and the median overall survival was 13 months.There was no additional toxicity.These results indicate that elderly patients with good KPS can achieve outcomes comparable to the current standard of care using an abbreviated radiotherapy course, radiosurgery boost, and temozolomide.

View Article: PubMed Central - PubMed

Affiliation: Beth Israel Deaconess Medical Center Boston, MA, USA ; Harvard Medical School Boston, MA, USA.

ABSTRACT
Glioblastoma Multiforme (GBM) is an aggressive primary brain neoplasm with dismal prognosis. Based on successful phase III trials, 60 Gy involved-field radiotherapy in 30 fractions over 6 weeks [Standard radiation therapy (RT)] with concurrent and adjuvant temozolomide is currently the standard of care. In this disease, age and Karnofsky Performance Status (KPS) are the most important prognostic factors. For elderly patients, clinical trials comparing standard RT with radiotherapy abbreviated to 40 Gy in 15 fractions over 3 weeks demonstrated similar outcomes, indicating shortened radiotherapy may be an appropriate option for elderly patients. However, these trials did not include temozolomide chemotherapy, and included patients with poor KPS, possibly obscuring benefits of more aggressive treatment for some elderly patients. We conducted a prospective Phase II trial to examine the efficacy of a hypofractionated radiation course followed by a stereotactic boost with concurrent and adjuvant temozolomide chemotherapy in elderly patients with good performance status. In this study, patients 65 years and older with a KPS > 70 and histologically confirmed GBM received 40 Gy in 15 fractions with 3D conformal technique followed by a 1-3 fraction stereotactic boost to the enhancing tumor. All patients also received concurrent and adjuvant temozolomide. Patients were evaluated 1 month post-treatment and every 2 months thereafter. Between 2007 and 2010, 20 patients (9 males and 11 females) were enrolled in this study. The median age was 75.4 years (range 65-87 years). At a median follow-up of 11 months (range 7-32 months), 12 patients progressed and 5 are alive. The median progression free survival was 11 months and the median overall survival was 13 months. There was no additional toxicity. These results indicate that elderly patients with good KPS can achieve outcomes comparable to the current standard of care using an abbreviated radiotherapy course, radiosurgery boost, and temozolomide.

No MeSH data available.


Related in: MedlinePlus