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Int J Radiat Oncol Biol Phys. 2014 Nov 15;90(4):877-85. doi: 10.1016/j.ijrobp.2014.07.014. Epub 2014 Sep 23.

Radiation therapy dose escalation for glioblastoma multiforme in the era of temozolomide.

Author information

1
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
2
Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
3
Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.
4
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri. Electronic address: jhuang@radonc.wustl.edu.

Abstract

PURPOSE:

To review clinical outcomes of moderate dose escalation using high-dose radiation therapy (HDRT) in the setting of concurrent temozolomide (TMZ) in patients with newly diagnosed glioblastoma multiforme (GBM), compared with standard-dose radiation therapy (SDRT).

METHODS AND MATERIALS:

Adult patients aged <70 years with biopsy-proven GBM were treated with SDRT (60 Gy at 2 Gy per fraction) or with HDRT (>60 Gy) and TMZ from 2000 to 2012. Biological equivalent dose at 2-Gy fractions was calculated for the HDRT assuming an α/β ratio of 5.6 for GBM.

RESULTS:

Eighty-one patients received SDRT, and 128 patients received HDRT with a median (range) biological equivalent dose at 2-Gy fractions of 64 Gy (61-76 Gy). Overall median follow-up time was 1.10 years, and for living patients it was 2.97 years. Actuarial 5-year overall survival (OS) and progression-free survival (PFS) rates for patients that received HDRT versus SDRT were 12.4% versus 13.2% (P=.71), and 5.6% versus 4.1% (P=.54), respectively. Age (P=.001) and gross total/near-total resection (GTR/NTR) (P=.001) were significantly associated with PFS on multivariate analysis. Younger age (P<.0001), GTR/NTR (P<.0001), and Karnofsky performance status ≥80 (P=.001) were associated with improved OS. On subset analyses, HDRT failed to improve PFS or OS for those aged <50 years or those who had GTR/NTR.

CONCLUSION:

Moderate radiation therapy dose escalation above 60 Gy with concurrent TMZ does not seem to improve clinical outcomes for patients with GBM.

Comment in

PMID:
25257812
DOI:
10.1016/j.ijrobp.2014.07.014
[Indexed for MEDLINE]

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