Simultaneous Integrated Boost Intensity-Modulated Radiotherapy in Patients With High-Grade Gliomas

Cho, Kwan Ho; Kim, Joo Young; Lee, Jun Young; Yoo, Heon; Shin, Sang Hoon; Moon, Sung Ho; Kim, Tae Hyun; Shin, Kyung Hwan; Yoon, Myonggeun; Lee, Doo Hyun; Pyo, Hong Ryull

doi:10.1016/j.ijrobp.2009.08.029

Cited by 54 publications

(37 citation statements)

References 22 publications

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“…The improvement in median survival beyond the addition of TMZ may relate to improved imaging techniques allowing better neurosurgical resection and RT . The extent of surgical resection has been demonstrated to be a favourable prognostic factor, and although influenced by neuroanatomical site the data over recent years suggests more patients being managed with aggressive resection.…”

Section: Discussionmentioning

confidence: 99%

Survival improvements with adjuvant therapy in patients with glioblastoma

Jayamanne

Wheeler

Cook

et al. 2017

ANZ Journal of Surgery

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This study confirms the significant improvement in median survival in GBM that has occurred in recent years since introduction of the EORTC-NCIC protocol. Further improvements have occurred presumably related to subspecialized care, improved resection rates, sophisticated radiotherapy targeting and early systemic salvage therapies. However, the burden of the disease within the community remains high and the median survival improvements over time have plateaued.

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Section: Discussionmentioning

confidence: 99%

Survival improvements with adjuvant therapy in patients with glioblastoma

Jayamanne

Wheeler

Cook

et al. 2017

ANZ Journal of Surgery

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“…Although surgery, radiotherapy, and chemotherapy can improve the prognosis [2], a recent comparative study showed that the one-year survival rate of GBM patients is 56 %, which is significantly poorer than those with grade III (78 %) or less malignant gliomas [3]. Therefore, grading of malignancy will provide accurate prognosis information and allow us to determine the best therapy [1,4].…”

Section: Introductionmentioning

confidence: 99%

18F-Fluoromisonidazole positron emission tomography may differentiate glioblastoma multiforme from less malignant gliomas

Hirata

Terasaka

Shiga

et al. 2012

Eur J Nucl Med Mol Imaging

107

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Glioblastoma multiforme (GBM) is the most aggressive primary brain tumor and its prognosis is significantly poorer than those of less malignant gliomas.Pathologically, necrosis is one of the most important characteristics that differentiate GBM from lower grade gliomas; therefore, we hypothesized that 18 F fluoromisonidazole (FMISO), a radiotracer for hypoxia imaging, accumulates in GBM but not in lower grade gliomas. We aimed to evaluate the diagnostic value of FMISO PET for the differential diagnosis of GBM from lower grade gliomas. Methods: This prospective study included 23 patients with pathologically confirmed gliomas. All the patients underwent FMISO PET and FDG PET within a week. FMISO images were acquired 4 hours after intravenous administration of 400 MBq of FMISO. Tracer uptake in the tumor was visually assessed. Lesion-to-normal tissue ratios and FMISO uptake volume were calculated. Results: Thirteen of the 23 glioma patients were diagnosed as having GBM (grade IV glioma in WHO classification 2007), and the others were diagnosed as having non-GBM (5 grade III and 4 grade II). In visual assessment, all the GBM patients showed FMISO uptake in the tumor greater than that in the surrounding brain tissues, whereas all the non-GBM patients showed FMISO uptake in the tumor equal to that in the surrounding brain tissues (p<0.001). One GBM patient was excluded 2 from FDG PET study because of hyperglycemia. All the GBM patients and 3 of the 9 (33 %) non-GBM patients showed FDG uptake greater than or equal to that in the gray matter. The sensitivity and specificity for diagnosing GBM were 100 % and 100 % for FMISO, and 100 % and 66 % for FDG, respectively. The lesion-to-cerebellum ratio of FMISO uptake was higher in GBM patients (2.74±0.60, range: 1.71 -3.81) than in non-GBM patients (1.22±0.06, range: 1.09 -1.29, p<0.001) with no overlap between the groups. The lesion-to-gray matter ratio of FDG was also higher in GBM patients (1.46±0.75, range: 0.91 -3.79) than in non-GBM patients (1.07±0.62, range: 0.66 -2.95, p<0.05); however, overlap of the ranges did not allow clear differentiation between GBM and non-GBM. Uptake volume of FMISO was larger in GBM (27.18±10.46 %, range: 14.02 -46.67 %) than in non-GBM (6.07±2.50 %, range: 2.12 -9.22 %, p<0.001). Conclusion: These preliminary data suggest that FMISO PET may distinguish GBM from lower grade gliomas.

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“…The standard SIB technique can create contrasts in the dose distribution, and is used for head and neck or brain tumors (25,26). However, the dose distribution in the tumor is homogeneous in the standard SIB technique, and the dose received by the tumor usually does not exceed the tolerance dose of the surrounding healthy tissue.…”

Section: Discussionmentioning

confidence: 99%

Modified simultaneous integrated boost radiotherapy for large retroperitoneal malignant tumor: A case report

Nomiya¹,

Akamatsu

Harada³

et al. 2015

Oncology Letters

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Abstract. The current study reports the case of a large retroperitoneal tumor treated with modified simultaneous integrated boost (SIB) radiotherapy. A 45-year-old female presented to the emergency department complaining of left abdominal pain and fever. A computed tomography scan detected a retroperitoneal tumor of 12x16x16 cm, and a biopsy revealed a poorly-differentiated adenocarcinoma. The patient was diagnosed with a large adenocarcinoma originating from the left ureter, with no distant metastasis. Due to the patient's poor physical condition, surgery was not recommended, and the patient was referred to the Department of Radiation Oncology (Yamagata University Hospital, Yamagata, Japan). Modified SIB radiotherapy was administered following the acquisition of written consent from the patient. The total irradiation dose to the center of the tumor and to the surrounding healthy tissue was ~96 Gy/33 fractions and <60 Gy/33 fractions, respectively. At the end of the radiotherapeutic course, the tumor volume was reduced by ≥80%, and the residual tumor was surgically resected. As a result of the resection, a complete pathological response was confirmed; the patient has been recurrence-free for >3 years with no complications. Modified SIB radiotherapy may be safely administered, with favorable outcomes. Complete recovery can be achieved with this technique, even in a patient with a large radioresistant tumor. IntroductionRetroperitoneal tumors arise from the tissues of the retroperitoneal space, which includes the following structures: The adrenal glands, kidneys, ureter, aorta, inferior vena cava, pancreas (part), duodenum, colon (part), rectum, esophagus, lymph nodes, and soft tissue. Although in other sites the incidence of a benign tumor is higher than that of a malignant tumor, the incidence of a malignant tumor in the peritoneum is ~4 times higher than that of a benign tumor (1). The majority of retroperitoneal tumors are malignant soft tissue tumors, lymphoproliferative disorders, and malignancies arising from parenchymal tissues (1).Approximately one-third of retroperitoneal tumors are soft tissue sarcomas, with liposarcoma and leiomyosarcoma accounting for ~70% and 15% of reteroperitoneal sarcomas, respectively (2). The retroperitoneum is the second most common site of origin of soft tissue tumors (2), with 10-15% of soft tissue sarcomas arising from the retroperitoneum (3,4). More rarely, Castleman's tumors (5), adult neuroblastoma (6), gastrinoma (7), solitary fibrous tumor of the pancreas (8), teratoma (9) and neurogenic tumors (10) have been reported to occur in this region. Due to the rarity of retroperitoneal large adenocarcinoma, literature regarding the surgical treatment of large retroperitoneal tumors is limited (11). Furthermore, no standard treatment exists for patients with inoperable large retroperitoneal tumors and thus, only palliative chemotherapy or radiotherapy or best supportive care is administered for these patients.Retroperitoneal tumors show few clinical symptoms in the early phase,...

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Simultaneous Integrated Boost Intensity-Modulated Radiotherapy in Patients With High-Grade Gliomas

Cited by 54 publications

References 22 publications

Survival improvements with adjuvant therapy in patients with glioblastoma

Survival improvements with adjuvant therapy in patients with glioblastoma

18F-Fluoromisonidazole positron emission tomography may differentiate glioblastoma multiforme from less malignant gliomas

Modified simultaneous integrated boost radiotherapy for large retroperitoneal malignant tumor: A case report

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