Fractionated Stereotactic Sequential Boost in a Selected Cohort of Glioblastoma Patients: A Mono-institutional Analysis

Marchionni, Alessandro; Palumbo, Isabella; Montesi, Giampaolo; Bini, Vittorio; Zucchetti, C.; Cenci, Nunzia; Chiarini, P; Saccia, S.; Aristei, Cynthia; Lupattelli, Marco

doi:10.21873/anticanres.14322

Cited by 2 publications

(2 citation statements)

References 27 publications

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“…The majority of patients with grade III or IV gliomas and selected patients with grade II gliomas are scheduled for radiochemotherapy, mainly following neurosurgical resection (4)(5)(6). This situation may produce significant emotional distress for the patients due to fears regarding the treatment procedure, potential side effects, and unsatisfactory treatment outcomes including progression or recurrence of the glioma (7)(8)(9)(10)(17)(18)(19). These fears may lead to sleep problems that can significantly impair the patients' quality of life (11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Sleep Problems Prior to Radiochemotherapy for Malignant Gliomas

Kopelke

Kjær

Tvilsted

et al. 2021

In Vivo

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Background/Aim: Many patients with malignant gliomas are scheduled for radiochemotherapy, which may cause emotional distress associated with sleep problems. This study aimed to determine the prevalence of such sleep problems in these patients and identify risk factors. Patients and Methods: Fifty-seven patients scheduled for radiochemotherapy for grade II-IV gliomas were retrospectively investigated for pre-treatment sleep problems. Fifteen characteristics were evaluated including temporal relation to age, gender, performance status, comorbidity, (family) history of malignancies, distress score, emotional problems, physical problems, practical problems, involved sites, glioma grade, upfront surgery, and corticosteroids. Results: Nineteen patients stated pre-treatment sleep problems (prevalence=66.7%). Significant associations with sleep problems were found for female gender (p=0.023), presence of emotional problems (p=0.006), and ≥4 physical problems (p<0.001). A trend was found for distress scores ≥5 (p=0.077). Conclusion: The prevalence of sleep problems was high. Risk factors were determined that can be used to identify patients who likely benefit from psychological support.According to the classification of the World Health Organization (WHO), the group of gliomas includes four grades (grades I to IV), of which grade IV tumors (glioblastoma multiforme) are the most aggressive lesions with a 5-year survival rate of about 5% (1-3).Neurosurgical resection should be performed whenever safely possible. In patients with grade III or IV gliomas, resection is generally followed by radiochemotherapy (4-6). This applies also to selected patients with grade II gliomas, mainly after incomplete resection. Assignment to a course of radiochemotherapy may cause significant distress for the patients who may be afraid particularly of the exposure to radiation and potential treatment-related adverse events (7-10). The distress may lead to sleep problems that can significantly impair the patients' quality of life and require psychological support already prior to the start of radiochemotherapy (11)(12)(13). Therefore, the present study investigated the prevalence and potential risk factors of pre-treatment sleep problems in patients with grade II to IV gliomas assigned to radiochemotherapy. These data can contribute to the identification of patients who would likely benefit from psychological support beginning already prior to their course of radiochemotherapy. Patients and MethodsIn this retrospective study, 57 patients scheduled for radiochemotherapy of WHO grade II-IV gliomas were investigated with respect to pre-treatment sleep problems. These patients had completed the National Comprehensive Cancer Network (NCCN) Distress Thermometer (14,15) between February 2019 and March 2021. The study was approved as a part of a larger project by the Ethics Committee of the University of Lübeck (reference 21-284). The technique to be used for the planned radiotherapy was volumetricmodulated arc therapy (VMAT). The preferred dose-frac...

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Sleep Problems Prior to Radiochemotherapy for Malignant Gliomas

Kopelke

Kjær

Tvilsted

et al. 2021

In Vivo

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“…The benefit of dose escalation in the treatment of glioblastoma remains controversial but recent meta-analysis highlights a survival gain in patients (Singh et al, 2021). Marchionni et al (2020) improved overall survival by 11 months by delivering a 20 Gy boost (four daily Â 5 Gy) to glioblastoma patients ( p = 0.004). Five daily fractions of 5 Gy of the 67% isodose (maximum dose in the planning target volume of 37.5 Gy) yielded a significantly longer progression free survival for recurrent glioblastomas (from four months without boost to nine months with boost) (Arpa et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

MRT-boost as the last fraction may be the most efficient irradiation schedule for increased survival times in a rat glioma model

Serduc

Bouchet

2023

J Synchrotron Rad

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Synchrotron microbeam radiation therapy (MRT) is based on the spatial fractionation of the incident synchrotron beam into arrays of parallel microbeams, typically a few tens of micrometres wide and depositing several hundred Gray. This high dose, high dose rate, spatially fractionated radiotherapy has a high therapeutic impact on tumors, especially in intracranial locations. MRT leads to better control of incurable high-grade glioma than from homogeneous radiotherapy. The schedule of MRT within a conventional irradiation protocol (three fractions of 11 Gy) of brain tumors was evaluated on the 9L glioma model in rats. MRT delivered as a first fraction increased the median survival time of the animals by four days compared with conventional radiotherapy, while the last MRT fraction improved the lifespan by 148% (+15.5 days compared with conventional radiotherapy, p < 0.0001). The most efficient radiation regimen was obtained when the MRT-boost was applied as the last fraction, following two conventional clinical exposures.

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Fractionated Stereotactic Sequential Boost in a Selected Cohort of Glioblastoma Patients: A Mono-institutional Analysis

Cited by 2 publications

References 27 publications

Risk Factors for Sleep Problems Prior to Radiochemotherapy for Malignant Gliomas

Risk Factors for Sleep Problems Prior to Radiochemotherapy for Malignant Gliomas

MRT-boost as the last fraction may be the most efficient irradiation schedule for increased survival times in a rat glioma model

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