Hypofractionated Radiotherapy in Glioblastoma Multiforme

Usman, Sadaf; Chaudry, Samreen Javed; Hameed, Shahid; Hussain, Kamran; Butt, Sumera

doi:10.37029/jcas.v1i2.31

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…However, Grade 1-2 radionecrosis was seen more frequently with HF-RT compared to CF-RT (20% versus 0%). The fourth group of studies [31][32][33][34][35][36], consisting of single-arm retrospective reports as well as older studies that used suboptimal doses and/or lack of concurrent chemotherapy, should be interpreted with caution and are not further described here.…”

Section: Systematic Review and Meta-analysis Of Literaturementioning

confidence: 99%

Moderately hypofractionated versus conventionally fractionated radiation therapy with temozolomide for young and fit patients with glioblastoma: an institutional experience and meta-analysis of literature

et al. 2022

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Purpose Shorter hypofractionated radiation therapy (HF-RT) schedules may have radiobiological, patient convenience and healthcare resource advantages over conventionally fractionated radiation therapy (CF-RT) in glioblastoma (GBM). We report outcomes of young, fit GBM patients treated with HF-RT and CF-RT during the COVID-19 pandemic, and a meta-analysis of HF-RT literature in this patient subgroup. Methods Hospital records of patients with IDH-wildtype GBM treated with HF-RT (50 Gy/20 fractions) and CF-RT (60 Gy/30 fractions) between January 2020 and September 2021 were reviewed. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Univariable analysis was performed using Cox regression analysis. A systematic search and meta-analysis of studies from January 2000 to January 2022 was performed. Results 41 patients were treated (HF-RT:15, CF-RT:26). For both HF-RT and CF-RT groups, median age was 58 years and 80–90% were ECOG 0–1. There were more methylated tumours in the HF-RT group. All patients received concurrent/adjuvant temozolomide. At 19.2 months median follow-up, median OS was 19.8 months and not-reached for HF-RT and CF-RT (p = 0.5), and median PFS was 7.7 and 5.8 months, respectively (p = 0.8). HF-RT or CF-RT did not influence OS/PFS on univariable analysis. Grade 3 radionecrosis rate was 6.7% and 7.7%, respectively. 15 of 1135 studies screened from a systematic search were eligible for meta-analysis. For studies involving temozolomide, pooled median OS and PFS with HF-RT were 17.5 and 9.9 months (927 and 862 patients). Studies using shortened HF-RT schedules reported 0–2% Grade 3 radionecrosis rates. Conclusion HF-RT may offer equivalent outcomes and reduce treatment burden compared to CF-RT in young, fit GBM patients.

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Section: Systematic Review and Meta-analysis Of Literaturementioning

confidence: 99%

Moderately hypofractionated versus conventionally fractionated radiation therapy with temozolomide for young and fit patients with glioblastoma: an institutional experience and meta-analysis of literature

et al. 2022

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“…Patients of either gender with ages between 40 -80 years clinically suspected of having a spaceoccupying lesion were included in the study. The exclusion criteria were (i) post-operative/post treatment patients and (ii) non availability of histopathological reports Sample size was calculated by using the WHO sample size calculator, taking the expected sensitivity and specificity of contrast enhanced MRI in determining GBM as 74.7% and 94.7% respectively 13 prevalence is taken as 54% 14 , desired precision for sensitivity as 0.09 and for sensitivity 0.05. The estimated sample size was 165.…”

Section: Meth Odo Log Ymentioning

confidence: 99%

Diagnostic Accuracy and Imaging Appearance Glioblastoma Multiforme on MRI and MRS

Naz

Chandani

Fatima³

et al. 2022

Ann Pak Inst Med Sci

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Objective: To determine the diagnostic accuracy of contrast-enhanced MRI with conventional sequences and MR Spectroscopy in the diagnosis of Glioblastoma Multiforme, taking histopathology as the gold standard. We also determined the MR imaging appearance of GBM on conventional sequences. Methodology: This descriptive cross-sectional study was conducted at a tertiary care hospital from 19th August 2019 to 18th August 2020 on 165 adult patients suspected of having an intracranial space-occupying lesion. Informed consent was sought and a questionnaire was filled out for patient data, MRI imaging findings, and MRS results. Histopathology results were subsequently followed and recorded. The diagnostic accuracy of contrast enhanced MRI brain as well as MRS was determined in terms of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy, taking histopathology as gold standard. Results: In a total of 165 patients selected for the study, the mean age was 56.34±10.04 years with a male to female ratio of 1:1 and the frontal lobe being the most common location (34.5%). In histopathological positive GBM cases, margins of the mass were ill-defined in 55.1%, intralesional low ADC values were observed in 63.3%, signal drop out on susceptibility imaging in 42.8%, and MRS with raised choline and reduced NAA in 75.5%. MRI had a sensitivity of 81.6% and specificity of 94.8%, and MRS has a sensitivity of 75.5% and a specificity of 100%. Conclusion: Ill-defined margins, necrosis, and hemorrhage are important MRI features suggesting GBM. MRS combined with conventional MR sequences has high sensitivity and specificity in its diagnosis.

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“…Approximately 12 to 37.5% of patients have been observed to progress during or toward the end of a conventionally fractionated radiation schedule. 4 One important biological intervention that has been evaluated to counter this is the use of HFRT. HFRT has the dual advantage of achieving increased cell kill from the higher dose per fraction and reducing the effect of accelerated repopulation by shortening overall treatment time.…”

Section: Introductionmentioning

confidence: 99%

Biological Dose Escalation—Do We Have a New Window of Opportunity in High-Grade Glioma?—A Feasibility Study

Joseph,

Parween,

Vishwanath

et al. 2024

South Asian J Cancer

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Despite multimodality treatment in high-grade glioma (HGG) involving maximal safe resection and adjuvant chemoradiotherapy, the prognosis remains dismal. In this study, we aimed to evaluate a method of biological enhancement by combining dose escalation with a condensed overall treatment time, aiming for maximal cytoreduction as a surrogate for improved outcomes. Hypofractionation has the dual advantage of enhanced cell kill with reduced overall treatment time. To this effect, we have employed a study involving hypofractionated simultaneous integrated boost (SIB) versus conventional treatment. As a secondary objective, we evaluated volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) in terms of optimal delivery technique for SIB boost. Forty patients were randomized into two arms, the study arm received 60 Gy in 25 fractions and the standard arm received 60 Gy in 30 fractions with concurrent and adjuvant temozolomide. The patients were assessed radiologically for tumor cytoreduction and acute toxicity parameters weekly during treatment, 6 weeks post-treatment, and 3 monthly follow-up. All patients were planned using VMAT and IMRT techniques in the study arm for the comparison of treatment time and dosimetric efficiency. However, the treatment was performed through VMAT technique. Data were analyzed using simple descriptive statistics including Student's t-tests, proportion tests, and Pearson correlation for association. The total sample size was estimated at 40, with 20 samples per group, providing a statistical power of 81% and a significance level (p-value) of 0.05. It was observed that tumor cytoreduction was significantly enhanced in a subgroup of patients in the study arm with smaller volume residual disease (p = 0.04) that was found at 6 weeks post-treatment evaluation. The tolerance, toxicity, and compliance were comparable in both arms. During the dosimetric evaluation, it was determined that VMAT had a significantly lower hot spot compared to the IMRT plan (64.22 Gy vs. 64.75 Gy, p = 0.02). It was also observed that the delivery with VMAT was faster and involved a lesser number of monitor units (555.7 MU vs. 679.6MU, p = 0.001). The hypofractionated SIB radiotherapy using the VMAT technique can provide a feasible method of biological dose enhancement without compromising toxicity and might have the future potential to improve local control in HGG.

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Hypofractionated Radiotherapy in Glioblastoma Multiforme

Cited by 3 publications

References 21 publications

Moderately hypofractionated versus conventionally fractionated radiation therapy with temozolomide for young and fit patients with glioblastoma: an institutional experience and meta-analysis of literature

Moderately hypofractionated versus conventionally fractionated radiation therapy with temozolomide for young and fit patients with glioblastoma: an institutional experience and meta-analysis of literature

Diagnostic Accuracy and Imaging Appearance Glioblastoma Multiforme on MRI and MRS

Biological Dose Escalation—Do We Have a New Window of Opportunity in High-Grade Glioma?—A Feasibility Study

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