Hyperfractionated radiation therapy and bis-chlorethyl nitrosourea in the treatment of malignant glioma—Possible advantage observed at 72.0 Gy in 1.2 Gy B.I.D. fractions: Report of the radiation therapy oncology group protocol 8302

Nelson, Diana F.; Curran, Walter J.; Scott, Charles; Nelson, James S.; Weinstein, Alan S.; Ahmad, Khurshid; Constine, Louis S.; Murray, Kevin; Powlis, William D.; Mohiuddin, Mohammed; Fischbach, Jennifer

doi:10.1016/0360-3016(93)90340-2

Cited by 155 publications

(36 citation statements)

References 21 publications

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“…Our results, i.e. increasing the dose from 60 to 70 Gy in conventional fractionation shows only a non-significant trend for the group with higher doses, are in agreement with those of other investigators [13,19]. This lack of an apparent advantage for dose increments of only 10 Gy might be due to the flat slope of the dose-effect curve in this range.…”

Section: Discussionsupporting

confidence: 81%

“…An increase of the dose from 60 Gy to 70 Gy using normofractionated radiotherapy with 2-D planning has not been shown to result in better survival [4,12]. It has been concluded that excessive radiation doses resulted in an increased frequency of radionecrosis, negating the benefits of the dose increase [13,14]. Schemes to allow a dose escalation whilst retaining an acceptable rate of late sideeffects include the use of hyperfractionation, where the total applied doses can exceed 60 Gy.…”

Section: Discussionmentioning

confidence: 99%

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Dose-Escalated Conformal Radiotherapy of Glioblastomas – Results of a Retrospective Comparison Applying Radiation Doses of 60 and 70 Gy

Graf¹,

Hildebrandt²,

Tilly³

et al. 2005

Oncol Res Treat

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Background: Dose escalated three-dimensional conformal radiotherapy with 70 Gy against glioblastomas was compared retrospectively with the standard scheme of 60 Gy using 2-D-planning. Patients and Methods: In the period from 1994 to 1998, a series of 135 patients with glioblastomas was treated by surgery and postoperative radiotherapy. A conversion from 2-D into 3-D-planning was carried out in 4/1996. The prescribed total dose for the first 65 patients was 60 Gy (group 60). A boost up to 70 Gy was added for the remaining 70 patients (group 70). Results: The median survival time was 8.0 months for group 60 and 8.3 months for group 70. A dependency on the applied dose range was found. The median survival time was 3 months for patients who received a radiation dose of 55 Gy or less, 8.6 months for doses between 56 and 65 Gy, and 9.6 months for patients with a dose between 66 and 75 Gy (p < 0.01). In a multivariate analysis only the performance status maintained significance (p = 0.02) as a prognostic factor, while the dose range reached borderline significance (p = 0.09). Conclusion: No statistically significant survival prolongation was reached despite a dose escalation to 70 Gy.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Dose-Escalated Conformal Radiotherapy of Glioblastomas – Results of a Retrospective Comparison Applying Radiation Doses of 60 and 70 Gy

Graf¹,

Hildebrandt²,

Tilly³

et al. 2005

Oncol Res Treat

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“…Furthermore, Phase 3 studies evaluating the role of 125 I interstitial implant or stereotactic radiosurgical boost following conventional EBRT have failed to show survival advantage [39][40][41]. Similarly, investigation of alternative radiation schedules including hyperfractionation to a total dose of 72 Gy reported no specific benefit [42].…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated radiotherapy for glioblastoma: strategy for poor-risk patients or hope for the future?

Hingorani¹,

Colley²,

Dixit³

et al. 2012

BJR

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ABSTRACT. The prognosis of patients with glioblastoma (GBM) remains poor, and the use of hyperfractionation or dose escalation beyond 60 Gy has not conferred any survival benefit. More recently, hypofractionated radiotherapy (HFRT) has been employed as a novel approach for achieving dose escalation, with interesting results. We present here a systematic overview of the role and development of HFRT as a possible therapeutic strategy in patients with GBM. We searched the PubMed database for studies published since 1990 that reported on the tolerance, safety and survival outcomes after HFRT. These studies reported on the paradox of improved survival in patients developing central radionecrosis within the high-dose volume. Most series reported no significant increase in early or late toxicity, except for one study that reported visual loss in one patient at 7 months after treatment. More recently, studies of HFRT combined with concurrent temozolomide (TMZ) reported a trend towards improved survival compared with historical controls, with a few studies reporting a median survival of approximately 20 months. The interpretation of data from the above studies is limited by the heterogeneities of patient population and the significant variation in the range of employed dose schedules. However, high-dose HFRT using intensity-modulated radiotherapy appears to be a safe and feasible therapeutic option. There is a suggestion of improved outcomes on combining HFRT with TMZ, which warrants further investigation in a randomised trial.

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“…Median survivals for the four treatment groups were: 6480 cGy-49 weeks (compared to our study 6141 cGy arm median survival of 46 weeks), 7200 cGy -55 weeks (corn- 68 pared to our study 7120 cGy arm median survival of 38 weeks), 7680 cGy-52 weeks and 8160 cGy-51 weeks (compared to our study 8000 cGy arm median survival of 45 weeks). There was no significant difference in survival among 6480 cGy, 7200 cGy and 7680cGy arms; however, patients treated on the 8160 cGy arm were found to survive for a significantly shorter period of time [22].…”

Section: Comparison To Radiation Therapy Oncology Group (Rtog) Study mentioning

confidence: 80%

Increasing radiation dose intensity using hyperfractionation in patients with malignant glioma

et al. 1992

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We attempted to show a dose effect relationship for radiation therapy by treating patients harbouring malignant glioma with increasing doses of radiation in a step-wise fashion. We postulated that no increase in delayed toxicity would be seen because we used hyperfractionation technique. Between January 1981 and December 1988 we treated 280 patients three times daily at 4 hour intervals. 100 patients received a total dose of 6141 cGy, 73 patients received 7120 cGy, and 107 patients received 8000 cGy. CCNU was given at the time of tumor progression following radiotherapy. Median time to tumor progression was 28 weeks for patients who received 6141 cGy, 27 weeks for patients who received 7120 cGy and 36 weeks for patients who received 8000 cGy. Median survival was 46 weeks for patients who received 6141 cGy, 38 weeks for patients who received 7120 cGy and 45 weeks for patients who received 8000 cGy. There was no statistically significant difference in either time to tumor progression or survival among the three treatment arms and no dose response effect was seen. There was no increase in delayed radiation toxicity when the total radiation dose was increased up to 8000 cGy.

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Hyperfractionated radiation therapy and bis-chlorethyl nitrosourea in the treatment of malignant glioma—Possible advantage observed at 72.0 Gy in 1.2 Gy B.I.D. fractions: Report of the radiation therapy oncology group protocol 8302

Cited by 155 publications

References 21 publications

Dose-Escalated Conformal Radiotherapy of Glioblastomas – Results of a Retrospective Comparison Applying Radiation Doses of 60 and 70 Gy

Dose-Escalated Conformal Radiotherapy of Glioblastomas – Results of a Retrospective Comparison Applying Radiation Doses of 60 and 70 Gy

Hypofractionated radiotherapy for glioblastoma: strategy for poor-risk patients or hope for the future?

Increasing radiation dose intensity using hyperfractionation in patients with malignant glioma

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