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Williamson C, Williamson S, Jiang R, Sudmeier L, Esiashvili N, Eaton BR. The impact of radiation therapy variables on pediatric high-grade glioma outcomes: A National Cancer Database analysis. Pediatr Blood Cancer 2024; 71:e30751. [PMID: 37937991 DOI: 10.1002/pbc.30751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/23/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE The purpose of this analysis is to report patterns of care for pediatric patients with high-grade glioma (pHGG) and evaluate the impact of radiotherapy (RT) variables on outcomes using the National Cancer Database (NCDB). METHODS Eligibility criteria included age < 22 years, histologically diagnosed WHO grade III-IV gliomas treated with ≥50 Gy and < 76 Gy RT between 2004 and 2013, and RT initiation within 90 days of diagnosis. RT variables including RT dose, RT timing, and RT modality were analyzed along with baseline demographic, tumor, and treatment variables to assess the impact on overall survival. RESULTS A total of 498 pHGG patients were included. The median age was 15 years (range, 0-21), common diagnoses were astrocytoma (55%) and glioblastoma (30%), 73.5% underwent surgical resection and 90.2% received chemotherapy. The median RT dose was 59.4 Gy (SD 2.9 Gy) starting at a median of 4.4 weeks from diagnosis (SD 2.5 weeks). Fourteen patients were treated with proton therapy. Median follow-up was 19.6 months with 1- and 3-year overall survival of 78.4% and 40.4%, respectively. On multivariable analysis, female gender, older age, and RT delay of ≥6 weeks were significantly associated with a lower rate of death; glioblastoma histology, no surgical resection/biopsy only, and earlier RT initiation < 6 weeks from diagnosis were associated with a higher rate of death. There was no relationship between RT dose or proton versus photon therapy and overall survival. CONCLUSIONS Outcomes for pHGG are poor. There was no benefit to early RT timing when RT is initiated within 90 days of diagnosis or higher RT dose in this dataset.
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Affiliation(s)
- Christopher Williamson
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Shayla Williamson
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Renjian Jiang
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Lisa Sudmeier
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Bree R Eaton
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
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Semyachkina-Glushkovskaya O, Sokolovski S, Fedosov I, Shirokov A, Navolokin N, Bucharskaya A, Blokhina I, Terskov A, Dubrovski A, Telnova V, Tzven A, Tzoy M, Evsukova A, Zhlatogosrkaya D, Adushkina V, Dmitrenko A, Manzhaeva M, Krupnova V, Noghero A, Bragin D, Bragina O, Borisova E, Kurths J, Rafailov E. Transcranial Photosensitizer-Free Laser Treatment of Glioblastoma in Rat Brain. Int J Mol Sci 2023; 24:13696. [PMID: 37762000 PMCID: PMC10530910 DOI: 10.3390/ijms241813696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
Over sixty years, laser technologies have undergone a technological revolution and become one of the main tools in biomedicine, particularly in neuroscience, neurodegenerative diseases and brain tumors. Glioblastoma is the most lethal form of brain cancer, with very limited treatment options and a poor prognosis. In this study on rats, we demonstrate that glioblastoma (GBM) growth can be suppressed by photosensitizer-free laser treatment (PS-free-LT) using a quantum-dot-based 1267 nm laser diode. This wavelength, highly absorbed by oxygen, is capable of turning triplet oxygen to singlet form. Applying 1267 nm laser irradiation for a 4 week course with a total dose of 12.7 kJ/cm2 firmly suppresses GBM growth and increases survival rate from 34% to 64%, presumably via LT-activated apoptosis, inhibition of the proliferation of tumor cells, a reduction in intracranial pressure and stimulation of the lymphatic drainage and clearing functions. PS-free-LT is a promising breakthrough technology in non- or minimally invasive therapy for superficial GBMs in infants as well as in adult patients with high photosensitivity or an allergic reaction to PSs.
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Affiliation(s)
- Oxana Semyachkina-Glushkovskaya
- Physics Department, Humboldt University, Newtonstrasse 15, 12489 Berlin, Germany;
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
| | - Sergey Sokolovski
- Optoelectronics and Biomedical Photonics Group, AIPT, Aston University, Birmingham B4 7ET, UK;
| | - Ivan Fedosov
- Physics Department, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (I.F.); (A.D.); (M.T.)
| | - Alexander Shirokov
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
- Institute of Biochemistry and Physiology of Plants and Microorganisms, Russian Academy of Sciences, Prospekt Entuziastov 13, 410049 Saratov, Russia
| | - Nikita Navolokin
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
- Department of Pathological Anatomy, Saratov Medical State University, Bolshaya Kazachaya Str. 112, 410012 Saratov, Russia;
| | - Alla Bucharskaya
- Department of Pathological Anatomy, Saratov Medical State University, Bolshaya Kazachaya Str. 112, 410012 Saratov, Russia;
| | - Inna Blokhina
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
| | - Andrey Terskov
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
| | - Alexander Dubrovski
- Physics Department, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (I.F.); (A.D.); (M.T.)
| | - Valeria Telnova
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
| | - Anna Tzven
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
| | - Maria Tzoy
- Physics Department, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (I.F.); (A.D.); (M.T.)
| | - Arina Evsukova
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
| | - Daria Zhlatogosrkaya
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
| | - Viktoria Adushkina
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
| | - Alexander Dmitrenko
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
| | - Maria Manzhaeva
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
| | - Valeria Krupnova
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
| | - Alessio Noghero
- Lovelace Biomedical Research Institute, Albuquerque, NM 87108, USA; (A.N.); (D.B.); (O.B.)
| | - Denis Bragin
- Lovelace Biomedical Research Institute, Albuquerque, NM 87108, USA; (A.N.); (D.B.); (O.B.)
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Olga Bragina
- Lovelace Biomedical Research Institute, Albuquerque, NM 87108, USA; (A.N.); (D.B.); (O.B.)
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Ekaterina Borisova
- Institute of Electronics, Bulgarian Academy of Sciences, Tsarigradsko Chaussee Blvd. 72, 1784 Sofia, Bulgaria;
| | - Jürgen Kurths
- Physics Department, Humboldt University, Newtonstrasse 15, 12489 Berlin, Germany;
- Department of Biology, Saratov State University, Astrakhanskaya Str. 83, 410012 Saratov, Russia; (A.S.); (N.N.); (I.B.); (A.T.); (V.T.); (A.T.); (A.E.); (D.Z.); (V.A.); (A.D.); (M.M.); (V.K.)
- Potsdam Institute for Climate Impact Research, Telegrafenberg A31, 14473 Potsdam, Germany
- Centre for Analysis of Complex Systems, Sechenov First Moscow State Medical University Moscow, 119991 Moscow, Russia
| | - Edik Rafailov
- Optoelectronics and Biomedical Photonics Group, AIPT, Aston University, Birmingham B4 7ET, UK;
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Kim Y, Kim KH, Park J, Yoon HI, Sung W. Prognosis prediction for glioblastoma multiforme patients using machine learning approaches: Development of the clinically applicable model. Radiother Oncol 2023; 183:109617. [PMID: 36921767 DOI: 10.1016/j.radonc.2023.109617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to develop a clinically applicable prognosis prediction model predicting overall survival (OS) and progression-free survival (PFS) for glioblastoma multiforme (GBM) patients. MATERIALS AND METHODS All 467 patients treated with concurrent chemoradiotherapy at Yonsei Cancer Center from 2016 to 2020 were included in this study. We developed a conventional linear regression, Cox proportional hazards (COX), and non-linear machine learning algorithms, random survival forest (RSF) and survival support vector machine (SVM) based on 16 clinical variables. After backward feature selection and hyperparameter tuning using grid search, we repeated 100 times of cross-validations to combat overfitting and enhance the model performance. Harrell's concordance index (C-index) and integrated brier score (IBS) were employed as quantitative performance metrics. RESULTS In both predictions, RSF performed much better than COX and SVM. (For OS prediction: RSF C-index = 0.72 90%CI [0.71-0.72] and IBS = 0.12 90%CI [0.10-0.13]; For PFS prediction: RSF C-index = 0.70 90%CI [0.70-0.71] and IBS = 0.12 90%CI [0.10-0.14]). Permutation feature importance confirmed that MGMT promoter methylation, extent of resection, age, cone down planning target volume, and subventricular zone involvement are significant prognostic factors for OS. The importance of the extent of resection and MGMT promoter methylation was much higher than other selected input factors in PFS. Our final models accurately stratified two risk groups with root mean square errors less than 0.07. The sensitivity analysis revealed that our final models are highly applicable to newly diagnosed GBM patients. CONCLUSION Our final models can provide a reliable outcome prediction for individual GBM. The final OS and PFS predicting models we developed accurately stratify high-risk groups up to 5-years, and the sensitivity analysis confirmed that both final models are clinically applicable.
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Affiliation(s)
- Yeseul Kim
- Department of Biomedical Engineering and of Biomedicine & Health Science, College of Medicine, The Catholic University of Korea, Seoul 137-70, South Korea
| | - Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Junyoung Park
- Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Wonmo Sung
- Department of Biomedical Engineering and of Biomedicine & Health Science, College of Medicine, The Catholic University of Korea, Seoul 137-70, South Korea.
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Semyachkina-Glushkovskaya O, Bragin D, Bragina O, Socolovski S, Shirokov A, Fedosov I, Ageev V, Blokhina I, Dubrovsky A, Telnova V, Terskov A, Khorovodov A, Elovenko D, Evsukova A, Zhoy M, Agranovich I, Vodovozova E, Alekseeva A, Kurths J, Rafailov E. Low-Level Laser Treatment Induces the Blood-Brain Barrier Opening and the Brain Drainage System Activation: Delivery of Liposomes into Mouse Glioblastoma. Pharmaceutics 2023; 15:567. [PMID: 36839889 PMCID: PMC9966329 DOI: 10.3390/pharmaceutics15020567] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
The progress in brain diseases treatment is limited by the blood-brain barrier (BBB), which prevents delivery of the vast majority of drugs from the blood into the brain. In this study, we discover unknown phenomenon of opening of the BBBB (BBBO) by low-level laser treatment (LLLT, 1268 nm) in the mouse cortex. LLLT-BBBO is accompanied by activation of the brain drainage system contributing effective delivery of liposomes into glioblastoma (GBM). The LLLT induces the generation of singlet oxygen without photosensitizers (PSs) in the blood endothelial cells and astrocytes, which can be a trigger mechanism of BBBO. LLLT-BBBO causes activation of the ABC-transport system with a temporal decrease in the expression of tight junction proteins. The BBB recovery is accompanied by activation of neuronal metabolic activity and stabilization of the BBB permeability. LLLT-BBBO can be used as a new opportunity of interstitial PS-free photodynamic therapy (PDT) for modulation of brain tumor immunity and improvement of immuno-therapy for GBM in infants in whom PDT with PSs, radio- and chemotherapy are strongly limited, as well as in adults with a high allergic reaction to PSs.
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Affiliation(s)
- Oxana Semyachkina-Glushkovskaya
- Institute of Physics, Humboldt University, Newtonstrasse 15, 12489 Berlin, Germany
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Denis Bragin
- Lovelace Biomedical Research Institute, Albuquerque, NM 87108, USA
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Olga Bragina
- Lovelace Biomedical Research Institute, Albuquerque, NM 87108, USA
| | - Sergey Socolovski
- Optoelectronics and Biomedical Photonics Group, Aston Institute of Photonic Technologies, Aston University, Birmingham B4 7ET, UK
| | - Alexander Shirokov
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
- Institute of Biochemistry and Physiology of Plants and Microorganisms, Russian Academy of Sciences, Prospekt Entuziastov 13, 410049 Saratov, Russia
| | - Ivan Fedosov
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Vasily Ageev
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Inna Blokhina
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Alexander Dubrovsky
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Valeria Telnova
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Andrey Terskov
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Alexander Khorovodov
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Daria Elovenko
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Arina Evsukova
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Maria Zhoy
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Ilana Agranovich
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Elena Vodovozova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Miklukho-Maklaya 16/10, 117997 Moscow, Russia
| | - Anna Alekseeva
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Miklukho-Maklaya 16/10, 117997 Moscow, Russia
| | - Jürgen Kurths
- Institute of Physics, Humboldt University, Newtonstrasse 15, 12489 Berlin, Germany
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
- Potsdam Institute for Climate Impact Research, Department of Complexity Science, Telegrafenberg A31, 14473 Potsdam, Germany
| | - Edik Rafailov
- Optoelectronics and Biomedical Photonics Group, Aston Institute of Photonic Technologies, Aston University, Birmingham B4 7ET, UK
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Li Z, Sun Q, Shi Y. Somatic structural variations in pediatric brain tumors. Minerva Pediatr (Torino) 2022; 74:358-364. [DOI: 10.23736/s2724-5276.17.04830-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, Colak O, Ozcan F, Gundem E, Elcim Y, Dirican B, Beyzadeoglu M. Concise review of stereotactic irradiation for pediatric glial neoplasms: Current concepts and future directions. World J Methodol 2021; 11:61-74. [PMID: 34026579 PMCID: PMC8127424 DOI: 10.5662/wjm.v11.i3.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
Abstract
Brain tumors, which are among the most common solid tumors in childhood, remain a leading cause of cancer-related mortality in pediatric population. Gliomas, which may be broadly categorized as low grade glioma and high grade glioma, account for the majority of brain tumors in children. Expectant management, surgery, radiation therapy (RT), chemotherapy, targeted therapy or combinations of these modalities may be used for management of pediatric gliomas. Several patient, tumor and treatment-related characteristics including age, lesion size, grade, location, phenotypic and genotypic features, symptomatology, predicted outcomes and toxicity profile of available therapeutic options should be considered in decision making for optimal treatment. Management of pediatric gliomas poses a formidable challenge to the physicians due to concerns about treatment induced toxicity. Adverse effects of therapy may include neurological deficits, hemiparesis, dysphagia, ataxia, spasticity, endocrine sequelae, neurocognitive and communication impairment, deterioration in quality of life, adverse socioeconomic consequences, and secondary cancers. Nevertheless, improved understanding of molecular pathology and technological advancements may pave the way for progress in management of pediatric glial neoplasms. Multidisciplinary management with close collaboration of disciplines including pediatric oncology, surgery, and radiation oncology is warranted to achieve optimal therapeutic outcomes. In the context of RT, stereotactic irradiation is a viable treatment modality for several central nervous system disorders and brain tumors. Considering the importance of minimizing adverse effects of irradiation, radiosurgery has attracted great attention for clinical applications in both adults and children. Radiosurgical applications offer great potential for improving the toxicity profile of radiation delivery by focused and precise targeting of well-defined tumors under stereotactic immobilization and image guidance. Herein, we provide a concise review of stereotactic irradiation for pediatric glial neoplasms in light of the literature.
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Affiliation(s)
- Omer Sager
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Ferrat Dincoglan
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Selcuk Demiral
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Bora Uysal
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Hakan Gamsiz
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Onurhan Colak
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Fatih Ozcan
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Esin Gundem
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Yelda Elcim
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Bahar Dirican
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Murat Beyzadeoglu
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
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Singla AK, Madan R, Gupta K, Goyal S, Kumar N, Sahoo SK, Uppal DK, Ahuja CK. Clinical behaviour and outcome in pediatric glioblastoma: current scenario. Radiat Oncol J 2021; 39:72-77. [PMID: 33794576 PMCID: PMC8024182 DOI: 10.3857/roj.2020.00591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/22/2020] [Indexed: 11/08/2022] Open
Abstract
Pediatric glioblastoma (pGBM) is a rare entity accounting for only approximately 3% of all childhood brain tumors. Treatment guidelines for pGBM have been extrapolated from those in adult glioblastoma. Rarity of pGBM and underrepresentation of pediatric population in major studies precludes from defining the ideal treatment protocol for these patients. Maximum safe resection is performed in most of the cases followed by postoperative radiotherapy in children over 3 years of age. Benefit of temozolomide is unclear in these patients. Here, we present the clinicopathological details and outcome of six pGBM patients treated at our institute in 2018–2019.
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Affiliation(s)
- Aditya Kumar Singla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Madan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shikha Goyal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narendra Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushant Kumar Sahoo
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K Uppal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag K Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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8
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Irradiation of pediatric glioblastoma cells promotes radioresistance and enhances glioma malignancy via genome-wide transcriptome changes. Oncotarget 2018; 9:34122-34131. [PMID: 30344926 PMCID: PMC6183347 DOI: 10.18632/oncotarget.26137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/08/2018] [Indexed: 01/05/2023] Open
Abstract
Pediatric glioblastoma (GBM) is a relatively rare brain tumor in children that has a dismal prognosis. Surgery followed by radiotherapy is the main treatment protocol used for older patients. The benefit of adjuvant chemotherapy is still limited due to a poor understanding of the underlying molecular and genetic changes that occur with irradiation of the tumor. In this study, we performed total RNA sequencing on an established stable radioresistant pediatric GBM cell line to identify mRNA expression changes following radiation. The expression of many genes was altered in the radioresistant pediatric GBM model. These genes have never before been reported to be associated with the development of radioresistant GBM. In addition to exhibiting an accelerated growth rate, radioresistant GBM cells also have overexpression of the DNA synthesis-rate-limiting enzyme ribonucleotide reductase, and pro-cathepsin B. These newly identified genes should be concertedly studied to better understand their role in pediatric GBM recurrence and progression after radiation. It was observed that the changes in multiple biological pathways protected GBM cells against radiation and transformed them to a more malignant form. These changes emphasize the importance of developing a treatment regimen that consists of a multiple-agent cocktail that acts on multiple implicated pathways to effectively target irradiated pediatric GBM. An alternative to radiation or a novel therapy that targets differentially expressed genes, such as metalloproteases, growth factors, and oncogenes and aim to minimize oncogenic changes following radiation is necessary to improve recurrent GBM survival.
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Botturi M, Fariselli L. Clinical Results of Unconventional Fractionation Radiotherapy in Central Nervous System Tumors. TUMORI JOURNAL 2018; 84:176-87. [PMID: 9620243 DOI: 10.1177/030089169808400215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Malignant brain tumors (primary and metastatic) are apparently resistant to most therapeutic efforts. Several randomized trials have provided evidence supporting the efficacy of radiation therapy. Attempts at improving the results of external beam radiotherapy include altered fractionation, radiation sensitizers and concomitant chemotherapy. In low-grade gliomas, all clinical studies with radiotherapy have employed conventional dose fractionation regimens. In high-grade gliomas, hypofractionation schedules represent effective palliative regimens in poor prognosis subsets of patients; short-term survival in these patients has not allowed to evaluate late toxicity. In tumors arising within the central nervous system, hyperfractionated irradiation exploits the differences in repair capacity between tumour and late responding normal tissues. It may allow for higher total dose and may result in increased tumor cell kill. Accelerated radiotherapy may reduce the repopulation of tumor cells between fractions. It may potentially improve tumor control for a given dose level, provided that there is no increase in late normal tissue injury. In supratentorial malignant gliomas, superiority of accelerated hyperfractionated over conventionally fractionated schedules was observed in a randomized trial; however, the gain in survival was less than 6 months. At present no other randomized trial supports the preferential choice for altered fractionation irradiation. Also in pediatric brainstem tumors there are no data to confirm the routine use of hyperfractionated irradiation, and significant late sequelae have been reported in the few long-term survivors. Shorter treatment courses with accelerated hyperfractionated radiotherapy may represent a useful alternative to conventional irradiation for the palliation of brain metastases. Different considerations have been proposed to explain this gap between theory and clinical data. Patients included in dose/effect studies are not stratified by prognostic factors and other treatment-related parameters. This observation precludes any definite conclusion about the relative role of conventional and of altered fractionation. New approaches are currently in progress. More prolonged radiation treatments, up to higher total doses, could delay time to tumor progression and improve survival in good prognosis subsets of patients; altered fractionation may be an effective therapeutic tool to achieve this goal.
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Affiliation(s)
- M Botturi
- Radiotherapy Department, Ospedale Niguarda Ca' Granda, Milan, Italy
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Walston S, Hamstra DA, Oh K, Woods G, Guiou M, Olshefski RS, Chakravarti A, Williams TM. A multi-institutional experience in pediatric high-grade glioma. Front Oncol 2015; 5:28. [PMID: 25741472 PMCID: PMC4332307 DOI: 10.3389/fonc.2015.00028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/27/2015] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Pediatric high-grade gliomas are rare tumors with poor outcomes and incompletely defined management. We conducted a multi-institutional retrospective study to evaluate association of clinical, pathologic, and treatment characteristics with outcomes. MATERIALS AND METHODS Fifty-one patients treated from 1984 to 2008 at the Ohio State University or University of Michigan were included. Histologic subgroups were compared. Log-rank and stepwise Cox proportional hazard modeling were used to analyze progression-free survival (PFS) and overall survival (OS) within the whole group, grade III subgroup, grade IV subgroup, and sub-total resection/biopsy subgroup. RESULTS Median OS was 27.6 months. Grade III histology, complete tumor resection, and cerebral tumor location correlated with improved PFS and OS. Temozolomide use and chemotherapy after radiotherapy or chemoradiation (CRT) were associated with better PFS while seizure at presentation was associated with better OS. In multivariate analysis, complete resection and chemotherapy following radiotherapy or CRT were independent predictors for improved PFS and OS. For grade III and IV subgroups, complete resection was associated with improved OS (grade III) and seizure presentation was associated with improved OS (grade IV). In the incompletely resection subgroup, temozolomide use and concurrent CRT independently correlated with improved PFS, while higher radiation dose (≥59.4 Gy) and adjuvant chemotherapy were independently associated with improved OS. DISCUSSION Total resection and receiving chemotherapy adjuvant to radiation or CRT are most closely associated with improved PFS and OS. For higher risk incompletely resected patients, temozolomide use and treatment intensification with concurrent CRT, adjuvant chemotherapy, and higher radiation dose were associated with improved outcomes.
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Affiliation(s)
- Steve Walston
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Daniel A Hamstra
- Department of Radiation Oncology, University of Michigan Health System , Ann Arbor, MI , USA
| | - Kevin Oh
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Gary Woods
- Department of Hematology-Oncology, Nationwide Children's Hospital , Columbus, OH , USA
| | - Michael Guiou
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Randal S Olshefski
- Department of Hematology-Oncology, Nationwide Children's Hospital , Columbus, OH , USA
| | - Arnab Chakravarti
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Terence M Williams
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
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11
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Mariani CL, Schubert TA, House RA, Wong MA, Hopkins AL, Barnes Heller HL, Milner RJ, Lester NV, Lurie DM, Rajon DA, Friedman WA, Bova FJ. Frameless stereotactic radiosurgery for the treatment of primary intracranial tumours in dogs. Vet Comp Oncol 2013; 13:409-23. [PMID: 24007303 DOI: 10.1111/vco.12056] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 06/01/2013] [Accepted: 06/24/2013] [Indexed: 11/29/2022]
Abstract
Stereotactic radiosurgery (SRS) is a procedure that delivers a single large radiation dose to a well-defined target. Here, we describe a frameless SRS technique suitable for intracranial targets in canines. Medical records of dogs diagnosed with a primary intracranial tumour by imaging or histopathology that underwent SRS were retrospectively reviewed. Frameless SRS was used successfully to treat tumours in 51 dogs with a variety of head sizes and shapes. Tumours diagnosed included 38 meningiomas, 4 pituitary tumours, 4 trigeminal nerve tumours, 3 gliomas, 1 histiocytic sarcoma and 1 choroid plexus tumour. Median survival time was 399 days for all tumours and for dogs with meningiomas; cause-specific survival was 493 days for both cohorts. Acute grade III central nervous system toxicity (altered mentation) occurred in two dogs. Frameless SRS resulted in survival times comparable to conventional radiation therapy, but with fewer acute adverse effects and only a single anaesthetic episode required for therapy.
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Affiliation(s)
- C L Mariani
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - T A Schubert
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - R A House
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - M A Wong
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - A L Hopkins
- North Florida Neurology, Orange Park, FL, USA
| | - H L Barnes Heller
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - R J Milner
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - N V Lester
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - D M Lurie
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - D A Rajon
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - W A Friedman
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - F J Bova
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
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12
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Fangusaro J. Pediatric high grade glioma: a review and update on tumor clinical characteristics and biology. Front Oncol 2012; 2:105. [PMID: 22937526 PMCID: PMC3426754 DOI: 10.3389/fonc.2012.00105] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 08/10/2012] [Indexed: 12/16/2022] Open
Abstract
High grade gliomas (HGG) are one of the most common central nervous system (CNS) tumors encountered in adults, but they only represent approximately 8–12% of all pediatric CNS tumors. Historically, pediatric HGG were thought to be similar to adult HGG since they appear histologically identical; however, molecular, genetic, and biologic data reveal that they are distinct. Similar to adults, pediatric HGG are very aggressive and malignant lesions with few patients achieving long-term survival despite a variety of therapies. Initial treatment strategies typically consist of a gross total resection (GTR) when feasible followed by focal radiotherapy combined with chemotherapy. Over the last few decades, a wealth of data has emerged from basic science and pre-clinical animal models helping to better define the common biologic, genetic, and molecular make-up of these tumors. These data have not only provided a better understanding of tumor biology, but they have also provided new areas of research targeting molecular and genetic pathways with the potential for novel treatment strategies and improved patient outcomes. Here we provide a review of pediatric non-brainstem HGG, including epidemiology, presentation, histology, imaging characteristics, treatments, survival outcomes, and an overview of both basic and translational research. An understanding of all relevant pre-clinical tumor models, including their strengths and pitfalls is essential in realizing improved patient outcomes in this population.
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Affiliation(s)
- Jason Fangusaro
- Pediatric Neuro-Oncology, The Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University Chicago, IL, USA
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13
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Abstract
Despite the recent progress in neurosurgery and development of new chemotherapy drugs, radiotherapy is still an essential method of combined treatment for pediatric central nervous system tumors. The new approach of radiotherapy, such as conformal and stereotactic methods have recently been developed. These new methods and recommendations for treatment of pediatric brain tumors, such as astrocytoma, medulloblastoma, and ependymoma are presented. The side effects of treatment are also considered. In addition, the perspective of future development of radiotherapy in central nervous system tumors is presented.
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Skowronska-Gardas A, Pedziwiatr K, Chojnacka M. Evaluation of quality of life in long-term survivors of paediatric brain stem tumors, treated with radiotherapy. Radiother Oncol 2004; 70:269-73. [PMID: 15064012 DOI: 10.1016/j.radonc.2004.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2003] [Revised: 01/14/2004] [Accepted: 01/29/2004] [Indexed: 11/27/2022]
Abstract
The quality of life in long-term survivors of paediatric brain stem tumors, treated with radiotherapy is evaluated. They suffer predominantly from pre-treatment neurological impairments, which seriously influence their quality of life. The most often observed treatment sequelae are pituitary insufficiency and hearing loss.
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Affiliation(s)
- Anna Skowronska-Gardas
- Department of Radiotherapy, M. Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, ul. Wawelska 15, Warsaw 00-973, Poland
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Short SC. External beam and conformal radiotherapy in the management of gliomas. ACTA NEUROCHIRURGICA. SUPPLEMENT 2004; 88:37-43. [PMID: 14531559 DOI: 10.1007/978-3-7091-6090-9_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
External beam radiotherapy remains an important local treatment modality in both high and low grade gliomas, however its contribution to outcome remains modest. In high grade tumours this is because of their extreme clinical radioresistance, with local recurrences occurring even after doses over 70 Gy. In low grade tumours radiation does not seem to alter the overall pattern of disease progression significantly. Therefore despite use of the new technologies now available that allow radiotherapy to be delivered more accurately and to higher doses, local control of these tumours is still rarely achieved. Unfortunately these tumours have not proven sensitive to changes in radiotherapy fractionation or to the addition of radiosensitising agents. Novel approaches to these tumours are needed, based on an improved understanding of both tumour and normal tissue response to radiation.
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Affiliation(s)
- S C Short
- Mount Vernon Cancer Centre and The Gray Cancer Institute, Northwood, Middlesex, UK.
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Tarnawski R, Sokol M, Pieniazek P, Maciejewski B, Walecki J, Miszczyk L, Krupska T. 1H-MRS in vivo predicts the early treatment outcome of postoperative radiotherapy for malignant gliomas. Int J Radiat Oncol Biol Phys 2002; 52:1271-6. [PMID: 11955739 DOI: 10.1016/s0360-3016(01)02769-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze prospectively the prognostic significance of 1H magnetic resonance spectroscopy (MRS) in vivo recorded from the tumor bed of patients after surgery for malignant glioma. METHODS AND MATERIALS Fifty-one patients aged 20-68 years were examined using a MRI/MRS system (Elscint 2T Prestige). Of the 51 patients, 33 had Grade 3 gliomas and 18 had glioblastomas. MRI-localized 1HMR spectra were acquired using a single-voxel, double-spin-echo sequence. Relative intensities of the signals (choline, creatine [Cr] N-acetyl aspartate [NAA], myo-inositol, lactate, and lipids) were obtained by numeric integration of fitted signals. Two voxels were examined, one located at the tumor bed and the second distant to the tumor bed. All patients were irradiated to 60 Gy using three-dimensional conformal noncoplanar techniques to 60 Gy. RESULTS MRS in vivo in patients after brain tumor surgery revealed a statistically significant decrease in the NAA/Cr ratio and increases in the choline/creatine (Cr), choline/NAA, and myo-inosytol/Cr ratios. The intensive signals of lactate and lipids appeared in spectrum. Survival correlated strongly with tumor grade and patient age but the strongest prognostic factor was the lactate/NAA ratio. For lactate/NAA values >2.0 (intensive lactate signal) the 1-year survival rate was 20%, and for lactate/NAA values <2.0, the 1-year survival rate was 85%. CONCLUSION A new diagnostic tool demonstrated ability to distinguish between patients with a favorable prognosis and those who will die within 1 year.
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Affiliation(s)
- Rafal Tarnawski
- Department of Radiotherapy, Centre of Oncology Maria Sklodowska-Curie Institute Branch in Gliwice, Gliwice, Poland.
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Sun LQ, Coucke PA, Mirimanoff RO, Buchegger F. Fractionated irradiation combined with carbogen breathing and nicotinamide of two human glioblastomas grafted in nude mice. Radiat Res 2001; 155:26-31. [PMID: 11121212 DOI: 10.1667/0033-7587(2001)155[0026:ficwcb]2.0.co;2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study addressed the potential radiosensitizing effect of nicotinamide and/or carbogen on human glioblastoma xenografts in nude mice. U-87MG and LN-Z308 tumors were irradiated with either 20 fractions over 12 days or 5 fractions over 5 days in air-breathing mice, mice injected with nicotinamide, mice breathing carbogen, or mice receiving nicotinamide plus carbogen. The responses to treatment were assessed using local control and moist desquamation. In U-87MG tumors, the enhancement ratios (ERs) at the radiation dose required to produce local tumor control in 50% of the treated mice (TCD(50)) with nicotinamide and/or carbogen ranged from 1.13 to 1.24 for irradiation in 20 fractions over 12 days. In LN-Z308 tumors, the ERs at the TCD(50) with nicotinamide and/or carbogen ranged from 1.22 to 1.40 for irradiation in 5 fractions over 5 days and from 1.11 to 1.30 in 20 fractions over 12 days, respectively. Skin injury was slightly enhanced, with ERs ranged from 1.06 to 1.15 when radiation was combined with carbogen and/or nicotinamide. Thus carbogen and nicotinamide can slightly improve the radiation response of human glioblastoma xenografts.
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Affiliation(s)
- L Q Sun
- Laboratory of Radiobiology, Department of Radiation Oncology, University Hospital of Lausanne, CH-1011 Lausanne, Switzerland
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18
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Schellinger PD, Meinck HM, Thron A. Diagnostic accuracy of MRI compared to CCT in patients with brain metastases. J Neurooncol 2000; 44:275-81. [PMID: 10720207 DOI: 10.1023/a:1006308808769] [Citation(s) in RCA: 197] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES In patients with extracranial neoplasms, the occurrence and number of brain metastases (BM) are critical for further diagnostic approaches and therapeutic strategies and the patient's prognosis. Although widely accepted, there is surprisingly little evidence in the literature that MRI is superior to CCT. Therefore, in patients with solitary BM according to diagnostic contrast-enhanced computed tomography (CCT), we investigated, what additional information could be gained by contrast-enhanced magnetic resonance imaging (MRI). METHODS/RESULTS Among 55 patients with solitary BM according to CCT, 17 had multiple BM on MRI (31%) and 38 had solitary BM in both. Based on a presumed binomial distribution of our data, we calculated a rate of at least 19% of patients with solitary BM on CCT, in which MRI would show multiple lesions (p = 0.05). The two main characteristics for BM missed by CCT were the smaller diameter, which averages 2 cm less than in BM identified with both modalities, and a preferential frontotemporal location. CONCLUSION MRI is indeed superior to CCT in the diagnosis of BM the essential reasons besides detection of smaller lesions being a better soft tissue contrast, significantly stronger enhancement with paramagnetic contrast agents, the lack of bone artifacts, fewer partial volume effects, and direct imaging in three different planes. Therefore, MRI is indispensable in the diagnostic workup of patients with BM for choosing the optimum therapeutic approach, especially with regard to the decision whether to operate or to primarily irradiate the patient's metastases.
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Lutterbach J, Weigel P, Guttenberger R, Hinkelbein W. Accelerated hyperfractionated radiotherapy in 149 patients with glioblastoma multiforme. Radiother Oncol 1999; 53:49-52. [PMID: 10624853 DOI: 10.1016/s0167-8140(99)00128-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Between August 1986 and December 1997, 149 patients with glioblastoma were treated postoperatively with 1.5 Gy fractions three times daily to a total dose of 54 Gy with 4-h intervals. Median actuarial survival was 8.8 months. Survival was 31% at 12 months and 4% at 24 months. No severe acute toxicity occurred. Multivariate analysis revealed that only age < or = 60 years and lactate dehydrogenase levels < or = 240 U/l predicted significantly higher survival probabilities.
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Affiliation(s)
- J Lutterbach
- Abteilung Strahlentherapie, Radiologische Universitätsklinik, Freiburg i.Br., Germany
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Nieder C, Nestle U, Ketter R, Kolles H, Gentner SJ, Steudel WI, Schnabel K. Hyperfractionated and accelerated-hyperfractionated radiotherapy for glioblastoma multiforme. RADIATION ONCOLOGY INVESTIGATIONS 1999; 7:36-41. [PMID: 10030622 DOI: 10.1002/(sici)1520-6823(1999)7:1<36::aid-roi5>3.0.co;2-o] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Because of promising radiobiological advantages allowing dose escalation and/or reduction of treatment time, hyperfractionated and accelerated-hyperfractionated radiotherapy (hf-rt, ahf-rt) were introduced as part of treatment of glioblastoma multiforme (gbm). In December 1988 we started a prospective study of hf-rt (total dose 78 Gy, two daily fractions of 1.3 Gy, interval between daily fractions 6 hr, treatment time 6 weeks, n = 34 patients). The results were compared with our previous regimen of conventionally fractionated radiotherapy (cf-rt: total dose 60 Gy, single dose 2 Gy, treatment time 6 weeks, n = 32 patients). In June 1990, the protocol was modified in order to reduce treatment time (ahf-rt: total dose 60 Gy, two daily fractions of 1.5 Gy, interval 6 hr, treatment time 4 weeks, n = 92 patients until December 1996). No chemotherapy was given. Entry criteria were: age > or = 17 years, pathological diagnosis of supratentorial gbm, and no previous treatment other than surgery. The ahf-rt group included significantly more patients with previous surgical resection instead of biopsy only. Compared with the cf-rt group, both the hf-rt and the ahf-rt group included significantly more patients with frontal tumor location. We found no significant survival difference between the groups (median survival 7-10 months, 1-year survival rate 19%-29%). Progression-free survival, clinical course, and toxicity were also not significantly different. Karnofsky performance status, age, and corticosteroid dose during radiotherapy were the most important prognostic factors. The results of this trial are in large agreement with most previous publications. It demonstrated no improved survival. However, it showed that treatment time can be reduced by ahf-rt without loss of survival benefit or intolerable toxicity. A short radiotherapy course might be appropriate for many patients with gbm who are not suitable for rather aggressive investigational therapies.
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Affiliation(s)
- C Nieder
- Department of Radiotherapy, University Hospital of Saarland, Homburg/Saar, Germany.
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Abstract
Success in the treatment of pediatric brain tumors has lagged behind that of other pediatric cancers. This paper highlights many of the advances that have taken place over the past few years in the surgical, radiotherapeutic, and chemotherapeutic approaches to central nervous system lesions that we hope will lead to a dramatic improvement in outcome. Innovations in neurosurgical and radiotherapeutic techniques have resulted in decreasing toxicity although substantial improvement in cure rates has not been observed. Many new techniques such as gene therapy, angiogenesis inhibitors, immunotherapy, and others that have not been part of the classic approach to these lesions are now in clinical trials in the hope that they will impact on the survival of these patients. The scientific basis for these new treatment modalities and preliminary clinical results are discussed.
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Affiliation(s)
- J B Rubin
- Dana Farber Cancer Institute, Department of Pediatric Oncology, Boston, MA 02115, USA
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