Elderly and poor prognosis patients with high grade glioma: hypofractionated radiotherapy.
Violante Di DonatoAlessia MonacoA. Di RolloDaniela MessineoL. SantuariAnnamaria CastrichinoRobert CaïazzoMaurizio SalvatiRoberto DelfiniEnzo Banelli
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To evaluate efficacy of short-course radiotherapy in elderly and/or poor performance status patients with high grade glioma.Twenty-one patients with high grade astrocytoma were selected in our Institute to receive hypofractionated radiotherapy. We considered two radiotherapy treatment arms: in arm I there were 22 patients treated with 60 Gy in 30 fractions at 5 fractions per week; in arm 2 there were 21 patients who received hypofractionated radiotherapy course of 30 Gy in 10 fractions at 5 fractions per week.In arm1 the median survival time was 8.2 months and the 1 year overall survival was 36%; in arm 2 the estimated median survival was 6.2 months and the 1 year overall survival was 23%. Treatment was without acute toxicity.In our experience, hypofractionated radiotherapy seems to be a reasonable treatment option for poor prognosis patients with high grade astrocytoma. It is well tolerated and can reduce the overall treatment time without negative effects on survival compared with conventional fractionation.Cite
Evidence shows that most high-grade gliomas are a diffuse process. Prior studies reported a median survival with surgery and postoperative radiotherapy of 8.6 months for glioblastoma multiforme (GBM) and 36.2 months for anaplastic astrocytoma (AA). Since MRI delineated the glioma better than CT scan, using MRI-based radiotherapy treatment planning allows for more precise treatment volumes. We retrospectively reviewed the records of the first 36 patients with malignant glioma, who had a presurgery MRI-based radiotherapy treatment planning. These patients were diagnosed between January 1986 and February 1991. Minimum follow up was 14 months and median survival was 15.4 months for GBM (7–42 months) and 27.4 months for AA (7–53 months). We feel that the trend for increased median survival in GBM (15.4 vs 8.6 months) is partly due to better definition of the tumor volume by using MRI. Larger studies are needed to confirm this finding.
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To evaluate efficacy of short-course radiotherapy in elderly and/or poor performance status patients with high grade glioma.Twenty-one patients with high grade astrocytoma were selected in our Institute to receive hypofractionated radiotherapy. We considered two radiotherapy treatment arms: in arm I there were 22 patients treated with 60 Gy in 30 fractions at 5 fractions per week; in arm 2 there were 21 patients who received hypofractionated radiotherapy course of 30 Gy in 10 fractions at 5 fractions per week.In arm1 the median survival time was 8.2 months and the 1 year overall survival was 36%; in arm 2 the estimated median survival was 6.2 months and the 1 year overall survival was 23%. Treatment was without acute toxicity.In our experience, hypofractionated radiotherapy seems to be a reasonable treatment option for poor prognosis patients with high grade astrocytoma. It is well tolerated and can reduce the overall treatment time without negative effects on survival compared with conventional fractionation.
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(1) Background: Proton minibeam radiation therapy (pMBRT) is a new radiotherapy technique using spatially modulated narrow proton beams. pMBRT results in a significantly reduced local tissue toxicity while maintaining or even increasing the tumor control efficacy as compared to conventional radiotherapy in small animal experiments. In all the experiments performed up to date in tumor bearing animals, the dose was delivered in one single fraction. This is the first assessment on the impact of a temporal fractionation scheme on the response of glioma-bearing animals to pMBRT. (2) Methods: glioma-bearing rats were irradiated with pMBRT using a crossfire geometry. The response of the irradiated animals in one and two fractions was compared. An additional group of animals was also treated with conventional broad beam irradiations. (3) Results: pMBRT delivered in two fractions at the biological equivalent dose corresponding to one fraction resulted in the highest median survival time, with 80% long-term survivors free of tumors. No increase in local toxicity was noted in this group with respect to the other pMBRT irradiated groups. Conventional broad beam irradiations resulted in the most severe local toxicity. (4) Conclusion: Temporal fractionation increases the therapeutic index in pMBRT and could ease the path towards clinical trials.
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Individuals suffering from diffuse intrinsic pontine glioma (DIPG) face a dismal prognosis with a median overall survival of approximately 11 months, and a 2-year survival rate of 10%. Long-term survival is very rare. To date, radiotherapy remains the standard of care at diagnosis, but offers a survival benefit of approximately 3 months. Chemotherapy has not shown to be effective. There is no Standard of Care for progressive DIPG after radiation therapy (RT). The purpose of this case report is to present the 23-year survival of a 26-year-old male treated with Antineoplaston therapy A10 and AS2-1 (ANP) for progressive DIPG.
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Aims and Background: To review if hyperfractionated radiotherapy provides better tumor control over standard radiotherapy for malignant glioma without chemotherapy.Methods: The records of 48 patients with glioblastoma multiforme or anaplastic astrocytoma treated with hyperfractionated/standard radiotherapy were reviewed for survival and prognostic factors analyses. The radiation schedule consisted of standard fractionation (1.8~2 Gy/day) or hyperfractionated fractionation (1.2~1.5 Gy twice/day with at least 6 hours interval), depending on the preference of different physicians. None of them received chemotherapy. Eight patients underwent biopsy only, and 28 patients underwent subtotal resection. The rest 12 patients had gross tumor resection. Survival rates were estimated using the method of Kaplan and Meier. In univariate analyses of survival time, the different variables were compared using the log rank test. Within the framework of Cox regression models, multivariate analysis was performed to differentiate the relationships between variables and their relevance to the survival.Results: No patient was lost to follow-up. Median survival was 13 months (range, 1-158 months). Two patients had complete response after radiotherapy. Twenty-two had partial response. The other 24 had stable disease or progression. The hyperfractionated radiotherapy group didn't show any benefit on survival (13 vs. 16.733 months, p=0.439). Age older than 50 years showed worse prognosis in both univariate and multivariate analyses. Tumor involvement more than one lobe, grossly total resection not achieved, and biologically equivalent dose (assuming α/β ratio=10) (BED10) less than 72 GyE had trends associating with worse prognosis, which were not statistically significant.Conclusion: In our study, patients didn't benefit from hyperfractionated radiotherapy. Due to small patient number, further investigation is warranted to evaluate the benefit and toxicity of hyperfractionated radiotherapy.
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This is an analysis of 37 previously untreated patients with squamous cell carcinoma of the maxillary sinus treated with curative intent at the University of Florida from January 1966 through January 1984. All patients were followed for at least two years and 86 per cent (32/27) were followed for a minimum of five years. Patients were treated for cure with radiation therapy alone (25), surgery alone (1), or surgery and preoperative (6) or postoperative (5) radiation therapy. This study presents the results of treatment and the incidence of treatment-related complications in this group of patients.
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Despite intensive multimodal treatment, outcome of patients with malignant glioma remains poor, and a standard dose of radiotherapy for anaplastic astrocytoma has not been defined. In the past RTOG study (83-02), the arm of 72 Gy hyperfractionated radiotherapy (HFRT) for malignant gliomas showed better outcome than the arms of higher doses (76.8 - 81.6 Gy) and the arms of lower doses (48 - 54.4 Gy). The purpose of this study is to verify the efficacy of this protocol.From July 1995, 44 consecutive eligible patients with histologically proven anaplastic astrocytoma were enrolled in this study (HFRT group). The standard regimen in this protocol was post-operative radiotherapy of 72 Gy in 60 fractions (1.2 Gy/fraction, 2 fractions/day) with concurrent chemotherapy (weekly ACNU). The primary endpoint was local control rate (LCR), and the secondary endpoints were overall survival (OS), progression-free survival (PFS) and late toxicity.Three-year OS of the HFRT group was 64.8% (95% confidence interval; 48.4-81.3%). Three-year PFS rate and LCR were 64.4% (95%CI: 48.4-80.3%) and 81.6% (95%CI: 69.2-94.8%), respectively. The number of failures at 5 years in the HFRT group were 14 (32%). The number of failures inside the irradiation field was only about half (50%) of all failures. One (2%) of the patients clinically diagnosed as brain necrosis due to radiation therapy.The results of this study suggested that 72 Gy HFRT seemed to show favorable outcome for patients with anaplastic astrocytoma with tolerable toxicity.
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