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Phase II trial of
functional imaging-optimized stereotactic fractionated radiotherapy plus
temozolomide for recurrent high-grade glioma
C. Nieder, N. Wiedenmann, S. Stark, A. L. Grosu
Klinikum Rechts der Isar, Munich, Germany
Background.
Stereotactic fractionated radiotherapy (SFRT) is a valuable
treatment option for recurrent high-grade glioma.
Its therapeutic ratio might be improved by functional imaging-optimized
treatment planning.
After this approach has been evaluated in 16 patients, additional chemotherapy
with temozolomide was added to the regimen in a single-institution phase II
trial.
Methods.
16 patients entered the SFRT alone trial, 30 patients received
SFRT plus temozolomide.
For treatment planning with the BrainLAB system, the gross tumor volume was
defined by C11-methionine PET/CT/MRI image fusion.
Maximum diameter was less than 4 cm.
Mean age was 50 years.
37 patients had glioblastoma multiforme, 8 anaplastic astrocytoma and 1
anaplastic oligodendroglioma.
Previous radiotherapy dose was 54-60 Gy (median interval to retreatment 17
months).
Total dose was 30 Gy in 6 fractions.
Temozolomide 200 mg/m2/day every 28 days was started before SFRT with
1-2 cycles.
After SFRT, 4+ cycles were added. Patients were followed with MRI or CT every
other cycle.
Results.
Median survival was 11 months for patients who received SFRT
plus temozolomide and 6 months for patients treated with SFRT alone
(p=0.02).
No acute neurologic toxicity grade II or higher was observed.
No grade IV hematologic toxicity was observed.
Signs of radionecrosis were observed in 3 patients.
However, surgical resection revealed both tumor and necrosis.
Conclusions.
This is the first study of functional imaging-optimized SFRT
plus temozolomide.
It demonstrates the feasibility and safety of this approach.
Our institutional retrospective comparison suggests a significant survival
advantage from combined modality treatment which needs to be confirmed
prospectively.
Copyright 2004 American Society of Clinical Oncology All rights
reserved worldwide.
Source: http://www.asco.org/ac/1,1003,_12-002636-00_18-0026-00_19-00474,00.asp
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