Hypofractionated stereotactic radiotherapy in the management of recurrent glioma

Shepherd, S.F.; Laing, Robert; Cosgrove, V.P.; Warrington, Alan P.; Hines, Frances; Ashley, S.; Brada, Michael

doi:10.1016/s0360-3016(96)00455-5

Cited by 168 publications

(96 citation statements)

References 15 publications

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“…The incidence of radiation damage reported in studies has ranged from 7% -36%. The highest incidence (36%) was reported by the Royal Marsden experience, where 36 patients with recurrent GBM (median tumor volume 24 cm 3 ) were treated with doses ranging from 20 -50 Gy in 5-Gy per fraction [17]. Following a fractionation scheme of 25 Gy/5 fractions, Ciammella, et al [11] reported neurological deterioration reversible with dexamethasone in 13% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Of these, HFSRT has emerged as a noninvasive method to deliver a high dose of radiation to the tumor site. In the treatment of recurrent GBM, numerous studies have documented a survival advantage on the use of HFSRT [10][11][12][13][14][15][16][17][18] and HFSRT in combination with chemotherapy [19][20][21][22][23][24]. Specifically, Iuchi, et al [25] has shown that a single dose of more than 20 Gy is able to achieve durable local control in 72% of patients; however, radiation necrosis (RN) was observed in 43% of patients.…”

Section: Introductionmentioning

confidence: 99%

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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

Jia

Pannullo

Schwartz

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Pannullo

Schwartz

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…Potential adverse effects include radiation necrosis, edema, hydrocephalus, and worsening of previous symptoms. Hypofractionated srs has similar survival outcomes, in the range of 9-12 months [49][50][51] .…”

Section: Re-irradiationmentioning

confidence: 96%

Canadian Recommendations for the Treatment of Recurrent or Progressive Glioblastoma Multiforme

Easaw¹,

Mason²,

Perry³

et al. 2011

Current Oncology

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Recommendation 1: Multidisciplinary Approach: To optimize treatment outcomes, the management of patients with recurrent glioblastoma should be individualized and should involve a multidisciplinary team approach, including neurosurgery, neuropathology, radiation oncology, neuro-oncology, and allied health professions. Recommendation 2: Imaging: The standard imaging modality for assessment of recurrent glioblastoma is Gd-enhanced magnetic resonance imaging (MRI). Tumour recurrence should be assessed according to the criteria set out by the Response Assessment in Neuro-Oncology Working Group. The optimal timing and frequency of MRI after chemoradiation and adjunctive therapy have not been established. Recommendation 3: Pseudo-progression: Progression observed by MRI after chemoradiation can be pseudo-progression. Accordingly, treated patients should not be classified as having progressive disease by Gd-enhancing MRI within the first 12 weeks after the end of radiotherapy unless new enhancement is observed outside the radiotherapy field or viable tumour is confirmed by pathology at the time of a required re-operation. Adjuvant temozolomide should be continued and follow-up imaging obtained. Recommendation 4: Repeat Surgery: Surgery can play a role in providing symptom relief and confirming tumour recurrence, pseudo-progression, or radiation necrosis. However, before surgical intervention, it is essential to clearly define treatment goals and the expected impact on prognosis and the patient’s quality of life. In the absence of level 1 evidence, the decision to re-operate should be made according to individual circumstances, in consultation with the multidisciplinary team and the patient. Recommendation 5: Re-irradiation: Re-irradiation is seldom recommended, but can be considered in carefully selected cases of recurrent glioblastoma. Recommendation 6: Systemic Therapy: Clinical trials, when available, should be offered to all eligible patients. In the absence of a trial, systemic therapy, including temozolomide rechallenge or antiangiogenic therapy, may be considered. Combination therapy is still experimental; optimal drug combinations and sequencing have not been established.

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“…En esta línea se han publicado varios trabajos que consideran volúmenes reducidos, con limitación de dosis por órganos críticos como son el tronco, médula, vía óptica, etc. no superando los 20-30 Gy y empleando distintos fraccionamientos desde el convencional, hasta el hipo o hiperfraccionamiento 5 . Los objetivos fundamentales, en estos casos, son conseguir estabilizar la enfermedad y paliar síntomas asumiendo un incremento de efectos adversos atribuibles a la reirradiación que puede elevarse hasta un 30%, con un riesgo de radionecrosis del 9-10%.…”

Section: La Radioterapia En Recidivas Localesunclassified

Radioterapia paliativa en niños: presentación de un caso clínico y recuerdo de sus indicaciones

Zapata¹,

Magallón²,

Valcárcel³

et al. 2004

Oncología (Barc.)

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Resumen• Propósito: conocer el papel de la radioterapia como tratamiento paliativo en la patología oncológica pediátrica.• Caso clínico: se comenta el caso de un niño de 10 años con neuroblastoma estadio IV de inicio que a pesar de sucesivos esquemas de tratamiento por progresión presentó metástasis cerebral única a los tres años del diagnóstico.• Resultados y conclusiones: revisada la literatura, se puede afirmar que la radioterapia es un tratamiento paliativo eficaz y adecuado cuando nuestro objetivo es controlar síntomas y ofrecer calidad de vida.

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Hypofractionated stereotactic radiotherapy in the management of recurrent glioma

Cited by 168 publications

References 15 publications

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

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

Canadian Recommendations for the Treatment of Recurrent or Progressive Glioblastoma Multiforme

Radioterapia paliativa en niños: presentación de un caso clínico y recuerdo de sus indicaciones

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