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Randomized comparison of stereotactic
radiosurgery followed by conventional radiotherapy with carmustine to
conventional radiotherapy with carmustine for patients with
glioblastoma multiforme: report of Radiation Therapy Oncology Group
93-05 protocol
Souhami L, Seiferheld W, Brachman D, Podgorsak EB, Werner-Wasik M,
Lustig R, Schultz CJ, Sause W, Okunieff P, Buckner J, Zamorano L,
Mehta MP, Curran WJ Jr
Department of Oncology, Division of Radiation Oncology, McGill
University, Montreal, Quebec, Canada. luis.souhami@muhc.mcgill.ca
Purpose. Conventional treatment of glioblastoma
multiforme (GBM) cures less than 5% of patients.
We investigated the effect of stereotactic radiosurgery (SRS) added to
conventional external beam radiation therapy (EBRT) with carmustine
(BCNU) on the survival of patients with GBM.
Methods and Materials. A
total of 203 patients with supratentorial GBM (tumor < or =40 mm)
were randomly assigned either to postoperative SRS followed by EBRT
(60 Gy) plus BCNU (80 mg/m(2) Days 1-3 every 8 weeks for six cycles)
or to EBRT with BCNU alone.
The dose of radiosurgery was tumor size-dependent and ranged from 15
Gy for largest to 24 Gy for smallest tumors.
RT and BCNU were identical in both arms.
Results. At a median
follow-up time of 61 months, the median survival in the radiosurgery
group was 13.5 months (95% confidence interval, 11.0-14.8) as compared
with 13.6 months (95% confidence interval, 11.2-15.2, p = 0.5711) for
the standard treatment group.
There were also no significant differences in 2- and 3-year survival
rates and in patterns of failure between the two arms.
Quality of life deterioration and cognitive decline at the end of
therapy, compared with baseline, were comparable and there was no
difference in quality-adjusted survival between the arms.
Conclusions. Stereotactic
radiosurgery followed by EBRT and BCNU does not improve the outcome in
patients with GBM nor does it change the general quality of life or
cognitive functioning.
PMID: 15465203 [PubMed - indexed for MEDLINE]
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