Limits...
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 A, Pano SC, Minkowitz S, Taube S, Chang J, Parashar B, Christos P, Wernicke AG - Cureus (2016)

Bottom Line: The remaining 16/21 patients (76.2%) died of disease.Treatment was well tolerated by all patients with no acute CTC/RTOG > Grade 2.There was 0% incidence of RN.

View Article: PubMed Central - HTML - PubMed

Affiliation: Stich Radiation Oncology, NewYork-Presbyterian/Weill Cornell Medical Center.

ABSTRACT
Management of recurrent glioblastoma multiforme (GBM) remains a challenge. Several institutions reported that a single fraction of ≥ 20 Gy for small tumor burden results in excellent local control; however, this is at the expense of a high incidence of radiation necrosis (RN). Therefore, we developed a hypofractionation pattern of 33 Gy/3 fractions, which is a radiobiological equivalent of 20 Gy, with the aim to lower the incidence of RN. We reviewed records of 21 patients with recurrent GBM treated with hypofractionated stereotactic radiation therapy (HFSRT) to their 22 respective lesions. Sixty Gy fractioned external beam radiotherapy was performed as first-line treatment. Median time from primary irradiation to HFSRT was 9.6 months (range: 3.1 - 68.1 months). In HFSRT, a median dose of 33 Gy in 11 Gy fractions was delivered to the 80% isodose line that encompassed the target volume. The median tumor volume was 1.07 cm3 (range: 0.11 - 16.64 cm3). The median follow-up time after HFSRT was 9.3 months (range: 1.7 - 33.6 months). Twenty-one of 23 lesions treated (91.3%) achieved local control while 2/23 (8.7%) progressed. Median time to progression outside of the treated site was 5.2 months (range: 2.2 - 9.6 months). Progression was treated with salvage chemotherapy. Five of 21 patients (23.8%) were alive at the end of this follow-up; two patients remain disease-free. The remaining 16/21 patients (76.2%) died of disease. Treatment was well tolerated by all patients with no acute CTC/RTOG > Grade 2. There was 0% incidence of RN. A prospective trial will be underway to validate these promising results.

No MeSH data available.


Related in: MedlinePlus

Representative images of MRI prior to and after therapy and radiation treatment plans of patients’ recurrent GBM tumors treated with stereotactic radiation(A) A right contrast-enhancing lesion in the superior centrum semiovale, visualized on a T1 contrast pre-treatment MRI scan (arrow). (B) A stereotactic radiation plan demonstrating isodose lines covering the target lesion. (C) A follow-up axial T1 contrast MRI scan demonstrating a resolution of the tumor on the at 22 months post-treatment (arrow). (D) A left contrast-enhancing lesion in the major forceps of the corpus callosum visualized on a T1 contrast pre-treatment MRI scan (arrow). (E) A stereotactic radiation plan demonstrating isodose lines covering the target lesion. (F) A follow-up axial T1 contrast MRI scan demonstrating tumor progression at 2.2 months post-treatment (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4835149&req=5

FIG1: Representative images of MRI prior to and after therapy and radiation treatment plans of patients’ recurrent GBM tumors treated with stereotactic radiation(A) A right contrast-enhancing lesion in the superior centrum semiovale, visualized on a T1 contrast pre-treatment MRI scan (arrow). (B) A stereotactic radiation plan demonstrating isodose lines covering the target lesion. (C) A follow-up axial T1 contrast MRI scan demonstrating a resolution of the tumor on the at 22 months post-treatment (arrow). (D) A left contrast-enhancing lesion in the major forceps of the corpus callosum visualized on a T1 contrast pre-treatment MRI scan (arrow). (E) A stereotactic radiation plan demonstrating isodose lines covering the target lesion. (F) A follow-up axial T1 contrast MRI scan demonstrating tumor progression at 2.2 months post-treatment (arrow).

Mentions: The median survival from completion of HFSRT was 9.3 months (range: 1.7 – 33.6 months); five patients were alive, two of whom were disease-free, and 16 patients were dead at the time of this review (Table 2). The median survival for lesions > 1 cm2 was 7.6 months (range: 1.7 – 16.0). There were two cases of local progression of disease within 5 mm of the resection cavity; one patient progressed at 2.2 months with a median survival of 5.9 months, and the other patient progressed at 9.6 months with a median survival of 10.0 months (Table 3). This yielded a median time to progression of 5.2 months. Both patients who progressed were receiving concomitant TMZ with HFSRT. Local control was achieved in 20/22 lesions (90.9%), where median survival was 9.3 months in these patients. Representative images of successful local control and progression are shown in Figure 1.


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 A, Pano SC, Minkowitz S, Taube S, Chang J, Parashar B, Christos P, Wernicke AG - Cureus (2016)

Representative images of MRI prior to and after therapy and radiation treatment plans of patients’ recurrent GBM tumors treated with stereotactic radiation(A) A right contrast-enhancing lesion in the superior centrum semiovale, visualized on a T1 contrast pre-treatment MRI scan (arrow). (B) A stereotactic radiation plan demonstrating isodose lines covering the target lesion. (C) A follow-up axial T1 contrast MRI scan demonstrating a resolution of the tumor on the at 22 months post-treatment (arrow). (D) A left contrast-enhancing lesion in the major forceps of the corpus callosum visualized on a T1 contrast pre-treatment MRI scan (arrow). (E) A stereotactic radiation plan demonstrating isodose lines covering the target lesion. (F) A follow-up axial T1 contrast MRI scan demonstrating tumor progression at 2.2 months post-treatment (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835149&req=5

FIG1: Representative images of MRI prior to and after therapy and radiation treatment plans of patients’ recurrent GBM tumors treated with stereotactic radiation(A) A right contrast-enhancing lesion in the superior centrum semiovale, visualized on a T1 contrast pre-treatment MRI scan (arrow). (B) A stereotactic radiation plan demonstrating isodose lines covering the target lesion. (C) A follow-up axial T1 contrast MRI scan demonstrating a resolution of the tumor on the at 22 months post-treatment (arrow). (D) A left contrast-enhancing lesion in the major forceps of the corpus callosum visualized on a T1 contrast pre-treatment MRI scan (arrow). (E) A stereotactic radiation plan demonstrating isodose lines covering the target lesion. (F) A follow-up axial T1 contrast MRI scan demonstrating tumor progression at 2.2 months post-treatment (arrow).
Mentions: The median survival from completion of HFSRT was 9.3 months (range: 1.7 – 33.6 months); five patients were alive, two of whom were disease-free, and 16 patients were dead at the time of this review (Table 2). The median survival for lesions > 1 cm2 was 7.6 months (range: 1.7 – 16.0). There were two cases of local progression of disease within 5 mm of the resection cavity; one patient progressed at 2.2 months with a median survival of 5.9 months, and the other patient progressed at 9.6 months with a median survival of 10.0 months (Table 3). This yielded a median time to progression of 5.2 months. Both patients who progressed were receiving concomitant TMZ with HFSRT. Local control was achieved in 20/22 lesions (90.9%), where median survival was 9.3 months in these patients. Representative images of successful local control and progression are shown in Figure 1.

Bottom Line: The remaining 16/21 patients (76.2%) died of disease.Treatment was well tolerated by all patients with no acute CTC/RTOG > Grade 2.There was 0% incidence of RN.

View Article: PubMed Central - HTML - PubMed

Affiliation: Stich Radiation Oncology, NewYork-Presbyterian/Weill Cornell Medical Center.

ABSTRACT
Management of recurrent glioblastoma multiforme (GBM) remains a challenge. Several institutions reported that a single fraction of ≥ 20 Gy for small tumor burden results in excellent local control; however, this is at the expense of a high incidence of radiation necrosis (RN). Therefore, we developed a hypofractionation pattern of 33 Gy/3 fractions, which is a radiobiological equivalent of 20 Gy, with the aim to lower the incidence of RN. We reviewed records of 21 patients with recurrent GBM treated with hypofractionated stereotactic radiation therapy (HFSRT) to their 22 respective lesions. Sixty Gy fractioned external beam radiotherapy was performed as first-line treatment. Median time from primary irradiation to HFSRT was 9.6 months (range: 3.1 - 68.1 months). In HFSRT, a median dose of 33 Gy in 11 Gy fractions was delivered to the 80% isodose line that encompassed the target volume. The median tumor volume was 1.07 cm3 (range: 0.11 - 16.64 cm3). The median follow-up time after HFSRT was 9.3 months (range: 1.7 - 33.6 months). Twenty-one of 23 lesions treated (91.3%) achieved local control while 2/23 (8.7%) progressed. Median time to progression outside of the treated site was 5.2 months (range: 2.2 - 9.6 months). Progression was treated with salvage chemotherapy. Five of 21 patients (23.8%) were alive at the end of this follow-up; two patients remain disease-free. The remaining 16/21 patients (76.2%) died of disease. Treatment was well tolerated by all patients with no acute CTC/RTOG > Grade 2. There was 0% incidence of RN. A prospective trial will be underway to validate these promising results.

No MeSH data available.


Related in: MedlinePlus