The Brain Tumor Cooperative Group NIH Trial 87-01: A Randomized Comparison of Surgery, External Radiotherapy, and Carmustine versus Surgery, Interstitial Radiotherapy Boost, External Radiation Therapy, and Carmustine

Selker, Robert G.; Shapiro, William R.; Burger, Peter C.; Blackwood, Margaret; Deutsch, Melvin; Arena, Vincent C.; Gilder, John C. Van; Wu, Julian K.; Malkin, Mark G.; Mealey, John; Neal, John H.; Olson, Jeffrey J.; Robertson, James T.; Barnett, Gene H.; Bloomfield, Stephen M.; Albright, Robert E.; Hochberg, Fred H.; Hiesiger, Emile M.; Green, Sylvan

doi:10.1097/00006123-200208000-00009

Cited by 209 publications

(35 citation statements)

References 48 publications

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“…Although prior retrospective studies have documented a modest survival advantage with the addition of SRS delivered using various technologies, 14,23,24,27,29,32,34,39 others have found no added benefit. 4,9,16,37,38 A single prospective randomized trial by the Radiation Therapy Oncology Group (RTOG 93-05) 42 found no improvement in overall survival (OS) when various forms of linear acceleratorand Gamma Knife-based SRS were given prior to conventional fractionated RT. 15 That study was not designed to evaluate the potential role of SRS at the time of GBM progression in patients who had received standard of care initial management.…”

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confidence: 99%

Role of adjuvant or salvage radiosurgery in the management of unresected residual or progressive glioblastoma multiforme in the pre–bevacizumab era

Niranjan

Kano

Iyer

et al. 2015

JNS

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abbreviatioNs ARE = adverse radiation effect; GBM = glioblastoma multiforme; KPS = Karnofsky Performance Scale; MST = median survival time; OS = overall survival; PFS = progression-free survival; RPA = recursive partitioning analysis; RT = radiation therapy; RTOG = Radiation Therapy Oncology Group; SRS = stereotactic radiosurgery. obJect After initial standard of care management of glioblastoma multiforme (GBM), relatively few proven options remain for patients with unresected progressive tumor. Numerous reports describe the value of radiosurgery, yet this modality appears to remain underutilized. The authors analyzed the outcomes of early adjuvant stereotactic radiosurgery (SRS) for unresected tumor or later salvage SRS for progressive GBM. Radiosurgery was performed as part of the multimodality management and was combined with other therapies. Patients continued to receive additional chemotherapy after SRS and prior to progression being documented. In this retrospective analysis, the authors evaluated factors that affected patient overall survival (OS) and progression-free survival. methods Between 1987 and 2008 the authors performed Gamma Knife SRS in 297 patients with histologically proven GBMs. All patients had received prior fractionated radiation therapy, and 66% had undergone one or more chemotherapy regimens. Ninety-six patients with deep-seated unresectable GBMs underwent biopsy only. Of those in whom excision had been possible, resection was considered to be gross total in 68 and subtotal in 133. The median patient age was 58 years (range 23-89 years) and the median tumor volume was 14 cm 3 (range 0.26-84.2 cm 3 ). The median prescription dose delivered to the imaging-defined tumor margin was 15 Gy (range 9-25 Gy). The median follow-up duration was 8.6 months (range 1.1-173 months). Cox regression models were used to analyze survival outcomes. Variables examined included age, residual versus recurrent tumor, prior chemotherapy, time to first recurrence, SRS dose, and gross tumor volume. results The median survival times after radiosurgery and after diagnosis were 9.03 and 18.1 months, respectively. The 1-year and 2-year OS after SRS were 37.9% and 16.7%, respectively. The 1-year and 2-year OS after diagnosis were 76.2% and 30.8%, respectively. Using multivariate analysis, factors associated with improved OS after diagnosis were younger age (< 60 years) at diagnosis (p < 0.0001), tumor volume < 14 cm 3 (p < 0.001), use of prior chemotherapy (p = 0.001), and radiosurgery at the time of recurrence (p < 0.0001). Multivariate analysis showed that younger age (p < 0.0001) and smaller tumor volume (< 14 cm 3 ) (p = 0.001) were significantly associated with increased OS after SRS. Adverse radiation effects were seen in 69 patients (23%). Fifty-eight patients (19.5%) underwent additional resection after SRS. The median survivals after diagnosis for recursive partitioning analysis Classes III, IV and V+VI were 31.6, 20.8, and 16.7 months, respectively. coNclusioNs In this analysis 30% of a heterogeneous cohort ...

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confidence: 99%

Role of adjuvant or salvage radiosurgery in the management of unresected residual or progressive glioblastoma multiforme in the pre–bevacizumab era

Niranjan

Kano

Iyer

et al. 2015

JNS

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“…One large randomized study by Selker and colleagues with 270 patients examined the use of interstitial brachytherapy in newly diagnosed high grade glioma 40 . Patients were randomized to two groups, one receiving resection, external beam radiation, and chemotherapy with the other group receiving resection, external beam radiation, chemotherapy, and 125 I permanent interstitial brachytherapy.…”

Section: Wwwintechopencommentioning

confidence: 99%

Innovative Surgical Management of Glioma

Seecharan¹,

Pollack²,

Farassati³

2012

Novel Therapeutic Concepts in Targeting Glioma

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“…After thorough analysis, these studies have failed to show significant benefits in terms of time to progression (TTP) or overall survival (OS) in these patients, including patients in two randomized controlled trials (Laperriere et al, 1998;Selker et al, 2002). Furthermore, a relevant number of radiation-induced necroses requiring subsequent surgical resection were described, which is attributed to the predominantly high activity/high dose rate implantation regimens chosen due to the high proliferation rate of these tumors.…”

Section: Sbt For High-grade Gliomas (Who III and Iv)mentioning

confidence: 99%

Stereotactic Brachytherapy for Brain Tumors

Ruge¹,

Grau²,

Treuer³

et al. 2012

Brachytherapy

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The Brain Tumor Cooperative Group NIH Trial 87-01: A Randomized Comparison of Surgery, External Radiotherapy, and Carmustine versus Surgery, Interstitial Radiotherapy Boost, External Radiation Therapy, and Carmustine

Abstract: We conclude that there is no long-term survival advantage of increased radiation dose with (125)I seeds in newly diagnosed glioma patients.

Cited by 209 publications

References 48 publications

Role of adjuvant or salvage radiosurgery in the management of unresected residual or progressive glioblastoma multiforme in the pre–bevacizumab era

Role of adjuvant or salvage radiosurgery in the management of unresected residual or progressive glioblastoma multiforme in the pre–bevacizumab era

Innovative Surgical Management of Glioma

Stereotactic Brachytherapy for Brain Tumors

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