19 juli 2012: Hypofractionated stereotactic radiation therapy: an effective therapy for recurrent high-grade gliomas volledig studie rapport uit 2010 toegevoegd onderaan artikel plus referentielijst van aan onderwerp gerelateerde studies.

Radiother Oncol. 2003 May;67(2):183-90.

Fractionele stereotactische bestraling na een normale post-operatieve bestralingsperiode geeft bij voorgeselecteerde patiënten met een hoog kwaadaardige hersentumor - glioma type - een significant betere en langere overleving in vergelijking wat mocht worden verwacht op basis van historische gegevens bij vergelijkbare groep patiënten. Hier zo goed als letterlijk vertaald de resultaten uit deze studie:

RESULTATEN: Alle patiënten werden behandeld met conventionele raduiotherapie een een SRT = stereotactische extra dosis (15 patiënten ontvingen 20 Gy en twee patiënten 10 Gy). Acute bijwerkingen waren moeheid (twee), verstoring van het korte termijn geheugen (een) en verergering van al bestaande symptomen (een). Geen enkele patiënt ontwikkelde stereoide afhankelijkheid na de SRT. Een patient werd opnieuw geopereerd voor necrotisch weefsel veroorzaakt door de bestraling. Binnen een mediane follow-up van 25 maanden (9-50 maanden) kregen 14 patiënten een lokaal recidief. 1 jaars overleving was 77% en 2 jaars overleving 42%; Porgressievrije - ziektevrije tijd was 70% na 1 jaar en 35% na 2 jaar voor alle patiënten. Mediane overleving is voor de hele patiëntengroep 20 maanden. Vergelijking met een historisch vergelijkbare groep toonde deze studie een significant betere overleving voor de groep behandeld met een extra dosis stereotactische bestraling. (P<0.0001).

Fractionated stereotactic radiotherapy boost after post-operative radiotherapy in patients with high-grade gliomas. Baumert BG, Lutterbach J, Bernays R, Davis JB, Heppner FL. Radiation-Oncology, University Hospital Zurich, Zurich, Switzerland. PURPOSE: To determine the value and the toxicity of an additional fractionated stereotactic boost as used in the joint randomized EORTC-22972/MRC-BR10 study in patients with malignant gliomas.

MATERIALS AND METHODS: Seventeen patients (11 male, six female) with a high-grade glioma (two WHO III, 15 WHO IV) < or =4 cm in maximum diameter, with a good performance status (WHO > or =2), were treated with a fractionated stereotactic radiotherapy (SRT) boost to 20 Gy in four fractions following partial brain irradiation to a dose of 60 Gy in 30 fractions. This patient group was compared with historical data in a matched-pair analysis.

RESULTS: All patients were treated by conventional radiotherapy and a SRT boost (15 patients received 20 Gy and two patients 10 Gy). Acute side effects included fatigue (two), impairment of short-term memory (one) and worsening of pre-existing symptoms (one). No patient developed steroid dependence after SRT. One patient was re-operated for radiation necrosis. At a median follow-up of 25 months (9-50 months) 14 patients recurred locally. Survival was 77% at 1 year and 42% at 2 years; progression-free survival was 70% at 1 year and 35% at 2 years for all patients, respectively. Median survival for the whole patient group is 20 months. Comparison with a matched historical group showed a significantly better survival for the group treated with a stereotactic boost (P<0.0001).

CONCLUSION: A fractionated stereotactic boost after standard external beam radiotherapy in selected patients with high-grade glioma is feasible and well tolerated with low toxicity. Compared to historical data survival is significantly better with an additional SRT boost. However, its effectiveness has to be proven in a randomized trial.

PMID: 12812849 [PubMed - indexed for MEDLINE]

Hypofractionated stereotactic radiation therapy: an effective therapy for recurrent high-grade gliomas

J Clin Oncol. 2010 Jun 20;28(18):3048-53. Epub 2010 May 17.

Hypofractionated stereotactic radiation therapy: an effective therapy for recurrent high-grade gliomas.

Fogh SE, Andrews DW, Glass J, Curran W, Glass C, Champ C, Evans JJ, Hyslop T, Pequignot E, Downes B, Comber E, Maltenfort M, Dicker AP, Werner-Wasik M.

Source

Department of Radiation Oncology, Neurological Surgery, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA. Shannon.fogh@jeffersonhospital.org

Erratum in

J Clin Oncol. 2010 Sep 20;28(27):4280.

Abstract

PURPOSE:

Salvage options for recurrent high-grade gliomas (HGGs) are limited by cumulative toxicity and limited efficacy despite advances in chemotherapeutic and radiotherapeutic techniques. Previous studies have reported encouraging survival results and favorable toxicity with fractionated stereotactic radiotherapy, and small studies have shown similar benefit using a shortened course of hypofractionated stereotactic radiation therapy (H-SRT). We sought to determine the efficacy and toxicity profile of H-SRT alone or in addition to repeat craniotomy or concomitant chemotherapy.

PATIENTS AND METHODS:

Between 1994 and 2008, 147 patients with recurrent HGG were treated with H-SRT (median dose, 35 Gy in 3.5-Gy fractions). Cox regression models were used to analyze survival outcomes. Variables included age, surgery before H-SRT, time to first recurrence, reirradiation dose, inclusion of chemotherapy with H-SRT, and gross tumor volume (GTV).

RESULTS:

Younger age (P = .001), smaller GTV (P = .025), and shorter time between diagnosis and recurrence (P = .034) were associated with improvement in survival from H-SRT. Doses of radiation > or = 35 Gy approached significance (P = .07). There was no significant benefit of surgical resection or chemotherapy in this population when analysis was controlled for other prognostic factors.

CONCLUSION:

H-SRT was well tolerated and resulted in a median survival time of 11 months after H-SRT, independent of re-operation or concomitant chemotherapy. Patients who experienced recurrence within 6 months after initial treatment had an excellent response and should not be disqualified from H-SRT. This is the largest series to examine the efficacy and tolerability of H-SRT in recurrent HGG.

Comment in

A thought-provoking retrospective study on survival and toxicity after reirradiation for recurrent high-grade gliomas. [J Clin Oncol. 2011]

PMID:: 20479391; [PubMed - indexed for MEDLINE]
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