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Innovative Hypofractionated Stereotactic Regimen Achieves Excellent Local Control with No Radiation Necrosis: Promising Results in the Management of Patients with Small Recurrent Inoperable GBM.

Al's Comment:

 This sounds like an ideal treatment for small recurrent gbms. They had local control (of the treated tumor) in over 90% of the tumors, although most people eventually died of tumors growing outside of the treated areas.   None had radiation necrosis which happens frequently with single fraction sterotactic radiosurgery. 

This may work well in combinations with other treatments to give them time to work.


Posted on: 05/05/2016

Cureus. 2016 Mar 17;8(3):e536. doi: 10.7759/cureus.536.
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 A1, Pannullo SC2, Minkowitz S3, Taube S1, Chang J1, Parashar B1, Christos P4, Wernicke AG1.
 
Author information:
1Stich Radiation Oncology, NewYork-Presbyterian/Weill Cornell Medical Center.
2Neurological Surgery, NewYork-Presbyterian/Weill Cornell Medical Center.
3Radiology, NewYork-Presbyterian/Weill Cornell Medical Center.
4Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, 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.
PMID: 27096136 [PubMed]

 


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