G Truc1, V Bernier2, C Mirjolet3, C Dalban4, F Mazoyer5, F Bonnetain6, N Blanchard7, É Lagneau8, P Maingon3, G Noël9. 1. Radiotherapy Department, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21079 Dijon, France. Electronic address: gtruc@cgfl.fr. 2. Radiotherapy Department, institut de cancérologie de Lorraine, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France. 3. Radiotherapy Department, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21079 Dijon, France. 4. Biostatistics and Epidemiological Unit, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21079 Dijon, France. 5. Radiation Physics Department, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21079 Dijon, France. 6. Methodology and Quality of Life in Oncology unit (EA 3181), CHU de Besançon, 25000 Besançon, France. 7. Radiotherapy Department, hôpital privé les Dentellières, 10, avenue Vauban, 59300 Valenciennes, France. 8. Radiotherapy Department, hôpital privé Drevon, 7, rue des Princes-de-Condé, 21000 Dijon, France. 9. Radiotherapy Department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67000 Strasbourg, France.
Abstract
PURPOSE: To evaluate the maximum tolerated dose of simultaneous integrated-boost intensity-modulated radiotherapy (SIB-IMRT) associated with temozolomide in patients with glioblastoma. PATIENTS AND METHODS: Between November 2009 and January 2012, nine patients with malignant glioma were enrolled in this phase I clinical trial. Radiotherapy was delivered using fractions of 2.5Gy on the planning target volume b and of 1.9Gy on the planning target volume a. Volumes were defined as follow: gross tumour volume b: tumour taking up contrast on T1 weighted MRI images; clinical target volume b: gross tumour volume b+0.5cm (adapted to the anatomical structures) and lastly planning target volume b: clinical target volume b+0.5cm; gross tumour volume a: tumour (gross tumour volume b)+2cm and including oedema outlined on T2Flair MRI sequences; clinical target volume a gross tumour volume a+0.5cm (adapted to the anatomical structures); planning target volume a: clinical target volume a+0.5cm. Three patients were enrolled at each of the three levels of dose (70, 75 and 80Gy prescribed on the planning target volume b and 56, 60 and 60.8Gy on the planning target volume a). Radiotherapy was delivered with temozolomide according to the standard protocol. Dose-limiting toxicities were defined as any haematological toxicities at least grade 4 or as any radiotherapy-related non-haematological acute toxicities at least grade 3, according to the Common Terminology Criteria for Adverse Events, version 3.0. RESULTS: Until the last dose level of 80Gy, no patient showed dose-limiting toxicity. CONCLUSIONS: SIB-IMRT, at least until a dose of 80Gy in 32 daily fractions, associated with temozolomide is feasible and well tolerated.
PURPOSE: To evaluate the maximum tolerated dose of simultaneous integrated-boost intensity-modulated radiotherapy (SIB-IMRT) associated with temozolomide in patients with glioblastoma. PATIENTS AND METHODS: Between November 2009 and January 2012, nine patients with malignant glioma were enrolled in this phase I clinical trial. Radiotherapy was delivered using fractions of 2.5Gy on the planning target volume b and of 1.9Gy on the planning target volume a. Volumes were defined as follow: gross tumour volume b: tumour taking up contrast on T1 weighted MRI images; clinical target volume b: gross tumour volume b+0.5cm (adapted to the anatomical structures) and lastly planning target volume b: clinical target volume b+0.5cm; gross tumour volume a: tumour (gross tumour volume b)+2cm and including oedema outlined on T2Flair MRI sequences; clinical target volume a gross tumour volume a+0.5cm (adapted to the anatomical structures); planning target volume a: clinical target volume a+0.5cm. Three patients were enrolled at each of the three levels of dose (70, 75 and 80Gy prescribed on the planning target volume b and 56, 60 and 60.8Gy on the planning target volume a). Radiotherapy was delivered with temozolomide according to the standard protocol. Dose-limiting toxicities were defined as any haematological toxicities at least grade 4 or as any radiotherapy-related non-haematological acute toxicities at least grade 3, according to the Common Terminology Criteria for Adverse Events, version 3.0. RESULTS: Until the last dose level of 80Gy, no patient showed dose-limiting toxicity. CONCLUSIONS: SIB-IMRT, at least until a dose of 80Gy in 32 daily fractions, associated with temozolomide is feasible and well tolerated.