Alvin R Cabrera1, John P Kirkpatrick2, John B Fiveash3, Helen A Shih4, Eugene J Koay5, Stephen Lutz6, Joshua Petit7, Samuel T Chao8, Paul D Brown5, Michael Vogelbaum9, David A Reardon10, Arnab Chakravarti11, Patrick Y Wen10, Eric Chang12. 1. Department of Radiation Oncology, Group Health Physicians, Seattle, Washington. Electronic address: acabrera@post.harvard.edu. 2. Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina. 3. Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama. 4. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. 5. Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas. 6. Department of Radiation Oncology, Blanchard Valley Regional Health Center, Findlay, Ohio. 7. Department of Radiation Oncology, University of Colorado Health, Fort Collins, Colorado. 8. Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio. 9. Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio. 10. Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. 11. Department of Radiation Oncology, Ohio State University, Columbus, Ohio. 12. Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California.
Abstract
PURPOSE: To present evidence-based guidelines for radiation therapy in treating glioblastoma not arising from the brainstem. METHODS AND MATERIALS: The American Society for Radiation Oncology (ASTRO) convened the Glioblastoma Guideline Panel to perform a systematic literature review investigating the following: (1) Is radiation therapy indicated after biopsy/resection of glioblastoma and how does systemic therapy modify its effects? (2) What is the optimal dose-fractionation schedule for external beam radiation therapy after biopsy/resection of glioblastoma and how might treatment vary based on pretreatment characteristics such as age or performance status? (3) What are ideal target volumes for curative-intent external beam radiation therapy of glioblastoma? (4) What is the role of reirradiation among glioblastoma patients whose disease recurs following completion of standard first-line therapy? Guideline recommendations were created using predefined consensus-building methodology supported by ASTRO-approved tools for grading evidence quality and recommendation strength. RESULTS: Following biopsy or resection, glioblastoma patients with reasonable performance status up to 70 years of age should receive conventionally fractionated radiation therapy (eg, 60 Gy in 2-Gy fractions) with concurrent and adjuvant temozolomide. Routine addition of bevacizumab to this regimen is not recommended. Elderly patients (≥70 years of age) with reasonable performance status should receive hypofractionated radiation therapy (eg, 40 Gy in 2.66-Gy fractions); preliminary evidence may support adding concurrent and adjuvant temozolomide to this regimen. Partial brain irradiation is the standard paradigm for radiation delivery. A variety of acceptable strategies exist for target volume definition, generally involving 2 phases (primary and boost volumes) or 1 phase (single volume). For recurrent glioblastoma, focal reirradiation can be considered in younger patients with good performance status. CONCLUSIONS: Radiation therapy occupies an integral role in treating glioblastoma. Whether and how radiation therapy should be applied depends on characteristics specific to tumor and patient, including age and performance status.
PURPOSE: To present evidence-based guidelines for radiation therapy in treating glioblastoma not arising from the brainstem. METHODS AND MATERIALS: The American Society for Radiation Oncology (ASTRO) convened the Glioblastoma Guideline Panel to perform a systematic literature review investigating the following: (1) Is radiation therapy indicated after biopsy/resection of glioblastoma and how does systemic therapy modify its effects? (2) What is the optimal dose-fractionation schedule for external beam radiation therapy after biopsy/resection of glioblastoma and how might treatment vary based on pretreatment characteristics such as age or performance status? (3) What are ideal target volumes for curative-intent external beam radiation therapy of glioblastoma? (4) What is the role of reirradiation among glioblastomapatients whose disease recurs following completion of standard first-line therapy? Guideline recommendations were created using predefined consensus-building methodology supported by ASTRO-approved tools for grading evidence quality and recommendation strength. RESULTS: Following biopsy or resection, glioblastomapatients with reasonable performance status up to 70 years of age should receive conventionally fractionated radiation therapy (eg, 60 Gy in 2-Gy fractions) with concurrent and adjuvant temozolomide. Routine addition of bevacizumab to this regimen is not recommended. Elderly patients (≥70 years of age) with reasonable performance status should receive hypofractionated radiation therapy (eg, 40 Gy in 2.66-Gy fractions); preliminary evidence may support adding concurrent and adjuvant temozolomide to this regimen. Partial brain irradiation is the standard paradigm for radiation delivery. A variety of acceptable strategies exist for target volume definition, generally involving 2 phases (primary and boost volumes) or 1 phase (single volume). For recurrent glioblastoma, focal reirradiation can be considered in younger patients with good performance status. CONCLUSIONS: Radiation therapy occupies an integral role in treating glioblastoma. Whether and how radiation therapy should be applied depends on characteristics specific to tumor and patient, including age and performance status.
Authors: Chengcheng Gui; Tracy D Vannorsdall; Lawrence R Kleinberg; Ryan Assadi; Joseph A Moore; Chen Hu; Alfredo Quiñones-Hinojosa; Kristin J Redmond Journal: Neurosurgery Date: 2020-07-01 Impact factor: 4.654
Authors: Deblina Dey; Vipan K Parihar; Gergely G Szabo; Peter M Klein; Jenny Tran; Jonathan Moayyad; Faizy Ahmed; Quynh-Anh Nguyen; Alexandria Murry; David Merriott; Brandon Nguyen; Jodi Goldman; Maria C Angulo; Daniele Piomelli; Ivan Soltesz; Janet E Baulch; Charles L Limoli Journal: Radiat Res Date: 2020-03-05 Impact factor: 2.841