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Hypofractionated
stereotactic radiotherapy in the management of recurrent glioma
Shepherd SF, Laing RW, Cosgrove VP, Warrington AP, Hines F, Ashley SE, Brada
M
Neurooncology Unit, The Royal Marsden Hospital, Surrey, United
Kingdom.
Purpose. This study aimed to assess the efficacy and toxicity of
hypofractionated stereotactic radiotherapy (SRT) in the management of patients
with recurrent glioma.
Methods
and Materials. From January 1989 to July 1994, 36 patients with glioma were
treated at the time of recurrence.
Twenty-nine had recurrent high-grade astrocytoma, 3 high-grade
oligodendroglioma, 1 high-grade ependymoma, and 3 pilocytic astrocytoma.
Hypofractionated stereotactic radiotherapy was given using either three
noncoplanar arcs or four to six noncoplanar fixed beams at 5 Gy/fraction, to
doses ranging from 20 to 50 Gy initially on a dose escalation program.
Two patients received 20 Gy, 8 received 30 Gy, 10 received 35 Gy, 10 received 40
Gy, 5 received 45 Gy, and 1 received 50 Gy, treating 5 days/week.
Results.
The median survival of 29 patients with recurrent high-grade astrocytoma was 11
months from the time of SRT.
This compared to a median survival of 7 months for a cohort matched for age,
performance status, and initial histologic grade who received nitrosourea-based
chemotherapy at recurrence (p < 0.05).
Initial low-grade astrocytoma histology was the only favorable prognostic factor
for survival on univariate analysis.
Three patients with recurrent oligodendroglioma remain alive 11, 23, and 34
months after SRT.
Three children treated for recurrent pilocytic astrocytoma remain alive 14, 41,
and 55 months following SRT.
Presumed radiation damage, defined as reversible steroid-dependent toxicity, was
observed in 13 patients (36%) and required reoperation in 2 (6%).
A total dose of >40 Gy was a major predictor of radiation damage (p <
0.005).
Conclusion.
Hypofractionated SRT is a noninvasive, well-tolerated, outpatient-based method
of delivering palliative, high-dose, focal irradiation.
PMID: 9069312 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9069312&dopt=Abstract |
