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Phase II trial of functional imaging-optimized stereotactic fractionated radiotherapy plus temozolomide for recurrent high-grade glioma.

Al Musella's Comments: (This is his personal views and are not necessarily the views of the Musella Foundation!)


Posted on: 06/08/2004

Phase II trial of functional imaging-optimized stereotactic fractionated radiotherapy plus temozolomide for recurrent high-grade glioma.

Meeting: 2004 ASCO Annual Meeting
Category: Central Nervous System Tumors
SubCategory: CNS Tumors

Abstract No: 1552
Author(s): C. Nieder, N. Wiedenmann, S. Stark, A. L. Grosu; Klinikum Rechts der Isar, Munich, Germany

Background: Stereotactic fractionated radiotherapy (SFRT) is a valuable treatment option for recurrent high-grade glioma. Its therapeutic ratio might be improved by functional imaging-optimized treatment planning. After this approach has been evaluated in 16 patients, additional chemotherapy with temozolomide was added to the regimen in a single-institution phase II trial.
Methods: 16 patients entered the SFRT alone trial, 30 patients received SFRT plus temozolomide. For treatment planning with the BrainLAB system, the gross tumor volume was defined by C11-methionine PET/CT/MRI image fusion. Maximum diameter was less than 4 cm. Mean age was 50 years. 37 patients had glioblastoma multiforme, 8 anaplastic astrocytoma and 1 anaplastic oligodendroglioma. Previous radiotherapy dose was 54-60 Gy (median interval to retreatment 17 months). Total dose was 30 Gy in 6 fractions. Temozolomide 200 mg/m2/day every 28 days was started before SFRT with 1-2 cycles. After SFRT, 4+ cycles were added. Patients were followed with MRI or CT every other cycle. Results: Median survival was 11 months for patients who received SFRT plus temozolomide and 6 months for patients treated with SFRT alone (p=0.02). No acute neurologic toxicity grade II or higher was observed. No grade IV hematologic toxicity was observed. Signs of radionecrosis were observed in 3 patients. However, surgical resection revealed both tumor and necrosis.

Conclusions: This is the first study of functional imaging-optimized SFRT plus temozolomide. It demonstrates the feasibility and safety of this approach. Our institutional retrospective comparison suggests a significant survival advantage from combined modality treatment which needs to be confirmed prospectively.

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