Accelerated fractionated proton/photon irradiation to 90 cobalt gray equivalent for glioblastoma multiforme: results of a phase II prospective trial

Fitzek, Markus M.; Thornton, Allan F.; Rabinov, James D.; Lev, Michael H.; Pardo, Francisco S.; Munzenrider, John E.; Okunieff, Paul; Bussière, Marc R.; Braun, Ilana M.; Hochberg, Fred H.; Hedley‐Whyte, E. Tessa; Liebsch, Norbert J.; Harsh, Griffith R.

doi:10.3171/jns.1999.91.2.0251

Cited by 231 publications

(115 citation statements)

References 33 publications

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“…Specifically, in a dose escalation trial by the Radiation Therapy Oncology Group, patients with glioblastoma multiforme treated to higher doses of 76.8 Gy or 81.6 Gy, at 1.2 Gy twice daily, had a slightly prolonged survival (11.6 months) as compared with patients treated with lower doses of 64.6 Gy or 72 Gy (10.2 months) (39) . In a phase II study using accelerated photon and proton therapy to a total dose of 90 cobalt Gy, overall survival was prolonged to 20 months, and all local failures but one occurred in volumes receiving doses of 70 Gy or less (40) . Finally, some institutional studies have demonstrated a survival benefit (median survival: 16 – 23 months) with a brachytherapy or radiosurgery boost added to involved‐field radiation therapy in patients with smaller tumors (41) .…”

Section: Discussionmentioning

confidence: 96%

Intensity modulated radiation therapy versus three‐dimensional conformal radiation therapy for the treatment of high grade glioma: a dosimetric comparison

MacDonald

Ahmad

Kachris

et al. 2007

J Applied Clin Med Phys

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The present study compared the dosimetry of intensity‐modulated radiation therapy (IMRT) and three‐dimensional conformal radiation therapy (3D‐CRT) techniques in patients treated for high‐grade glioma. A total of 20 patients underwent computed tomography treatment planning in conjunction with magnetic resonance imaging fusion. Prescription dose and normal‐tissue constraints were identical for the 3D‐CRT and IMRT plans. The prescribed dose was 59.4 Gy delivered at 1.8 Gy per fraction using 4 – 10 MV photons. Normal‐tissue dose constraints were 50 – 54 Gy for the optic chiasm and nerves, and 55 – 60 Gy for the brainstem.The IMRT plan yielded superior target coverage as compared with the 3D‐CRT plan. Specifically, minimum and mean planning target volume cone down doses were 54.52 Gy and 61.74 Gy for IMRT and 50.56 Gy and 60.06 Gy for 3D‐CRT (p≤0.01). The IMRT plan reduced the percent volume of brainstem receiving a dose greater than 45 Gy by 31% (p=0.004) and the percent volume of brain receiving a dose greater than 18 Gy, 24 Gy, and 45 Gy by 10% (p=0.059), 14% (p=0.015), and 40% (p≤0.0001) respectively. With IMRT, the percent volume of optic chiasm receiving more than 45 Gy was also reduced by 30.40% (p=0.047). As compared with 3D‐CRT, IMRT significantly increased the tumor control probability (p≤0.005) and lowered the normal‐tissue complication probability for brain and brainstem (p<0.033).Intensity‐modulated radiation therapy improved target coverage and reduced radiation dose to the brain, brainstem, and optic chiasm. With the availability of new cancer imaging tools and more effective systemic agents, IMRT may be used to intensify tumor doses while minimizing toxicity, therefore potentially improving outcomes in patients with high‐grade glioma.PACs number: 87.53 Tf

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Section: Discussionmentioning

confidence: 96%

Intensity modulated radiation therapy versus three‐dimensional conformal radiation therapy for the treatment of high grade glioma: a dosimetric comparison

MacDonald

Ahmad

Kachris

et al. 2007

J Applied Clin Med Phys

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“…Computerized tomography (CT) and magnetic resonance imaging (MRI) are currently used to delineate the target volume for high grade gliomas with MRI providing superior soft tissue contrast [5][6][7]. Target volumes for 3D conformal radiation therapy (3D-CRT) are defined to cover the Gadolinium contrast enhancing region on T1-weighted images obtained from MRI with a uniform margin of 1 to 4 cm [1,[8][9][10] and/or the area of hyperintense lesion on T2-weighted MRI enlarged by several centimeters [11,12].…”

Section: Introductionmentioning

confidence: 99%

Patterns of Recurrence Analysis in Newly Diagnosed Glioblastoma Multiforme After Three-Dimensional Conformal Radiation Therapy With Respect to Pre–Radiation Therapy Magnetic Resonance Spectroscopic Findings

Park

Tamai

Lee

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To determine whether the combined MRI and MR spectroscopy imaging (MRSI) prior to radiation therapy (RT) is valuable for RT target definition, and to evaluate the feasibility of replacing the current definition of uniform margins by custom shaped margins based on the information from MRI and MRSI.Methods and Materials-Twenty three GBM patients underwent MRI and MRSI within 4 weeks after surgery but before the initiation of RT and at two month follow-up (FU) intervals thereafter. MRSI data were quantified on the basis of a Choline-to-NAA Index (CNI) as a measure of spectroscopic abnormality. A combined anatomic and metabolic ROI (MRI/S) consisting of T2-weighted hyperintensity, contrast enhancement (CE), resection cavity and CNI2 based on the pre-RT imaging was compared to CNI2 extent and RT dose distribution. The spatial relationship of the pre-RT MRI/S and the RT dose volume was compared to the extent of CE at each FU.Results-Nine patients showed new or increased CE during FU, and 14 patients were either stable or had decreased CE. New or increased areas of CE occurred within CNI2 that was covered by 60 Gy in six patients and within the CNI2 that was not entirely covered by 60 Gy in three patients. New or increased CE resided within the pre-RT MRI/S lesion in 89 % (8/9) of the patients with new or increased CE.Conclusion-These data indicate that the definition of RT target volumes according to the combined morphologic and metabolic abnormality may be sufficient for RT targeting.

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“…Currently, most glioblastoma patients receive proton therapy with a dose standard of 60 Gy, with concurrent chemotherapy. However, clinical trials suggest success and better overall Enhancement of Tumor Regression by Coulomb Nanoradiator Effect in Proton Treatment of Iron-Oxide Nanoparticle-Loaded Orthotopic Rat Glioma Model: 26 Implication of Novel Particle Induced Radiation Therapy survival rates with higher dosing [1,2]. The two-year overall survival rate for patients treated with the current standard of care is 26.5 percent.…”

Section: Introductionmentioning

confidence: 99%

Enhancement of Tumor Regression by Coulomb Nanoradiator Effect in Proton Treatment of Iron-Oxide Nanoparticle-Loaded Orthotopic Rat Glioma Model: Implication of Novel Particle Induced Radiation Therapy

Seo¹,

Jeon²,

Jeong³

et al. 2013

JCT

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Background: Proton-impact metallic nanoparticles, inducing low-energy electrons emission and characteristic X-rays termed as Coulomb nanoradiator effect (CNR), are known to produce therapeutic enhancement in proton treatment on experimental tumors. The purpose of this pilot study was to investigate the effect of CNR-based dose enhancement on tumor growth inhibition in an iron-oxide nanoparticle (FeONP)-loaded orthotopic rat glioma model. Methods: Proton-induced CNR was exploited to treat glioma-bearing SD rat loaded with FeONP by either fully-absorbed single pristine Bragg peak (APBP) or spread-out Bragg peak (SOBP) 45-MeV proton beam. A selected number of rats were examined by MRI before and after treatment to obtain the size and position information for adjusting irradiation field. Tumor regression assay was performed by histological analysis of residual tumor in the sacrificed rats 7 days after treatment. The results of CNR-treated groups were compared with the proton alone control. Results: Intravenous injection of FeONP (300 mg/kg) elevated the tumor concentration of iron up to 37 μg of Fe/g tissue, with a tumor-to-normal ratio of 5, 24 hours after injection. The group receiving FeONP and proton beam showed 65% -79% smaller tumor volume dose-dependently compared with the proton alone group. The rats receiving FeONP and controlled irradiation field by MR imaging demonstrated more than 95% -99% tumor regression compared with MRI-determined initial tumor size. Conclusions: Proton-impact FeONP produced therapeutic enhancement compared with proton alone in an orthotopic rat glioma model at a selected temporal point after treatment. Single BP proton beam could induce CNRbased dose enhancement and produce enhanced tumor regression that was comparable to SOBP treatment despite inhomogeneous tumor dose in the APBP-treated tumor. These results may suggest emergence of novel Particle Induced Radiation Therapy (PIRT) on malignant glioma.

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Accelerated fractionated proton/photon irradiation to 90 cobalt gray equivalent for glioblastoma multiforme: results of a phase II prospective trial

Cited by 231 publications

References 33 publications

Intensity modulated radiation therapy versus three‐dimensional conformal radiation therapy for the treatment of high grade glioma: a dosimetric comparison

Intensity modulated radiation therapy versus three‐dimensional conformal radiation therapy for the treatment of high grade glioma: a dosimetric comparison

Patterns of Recurrence Analysis in Newly Diagnosed Glioblastoma Multiforme After Three-Dimensional Conformal Radiation Therapy With Respect to Pre–Radiation Therapy Magnetic Resonance Spectroscopic Findings

Enhancement of Tumor Regression by Coulomb Nanoradiator Effect in Proton Treatment of Iron-Oxide Nanoparticle-Loaded Orthotopic Rat Glioma Model: Implication of Novel Particle Induced Radiation Therapy

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