Silvia Scoccianti1, Marco Krengli2, Livia Marrazzo3, Stefano Maria Magrini4, Beatrice Detti5, Vincenzo Fusco6, Luigi Pirtoli7, Daniela Doino8, Alba Fiorentino9, Laura Masini2, Daniela Greto5, Michela Buglione4, Giovanni Rubino7, Federico Lonardi10, Fernanda Migliaccio11, Salvino Marzano12, Riccardo Santoni13, Umberto Ricardi14, Lorenzo Livi5. 1. Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. silvia.scoccianti@unifi.it. 2. Radiotherapy Unit, Department of Translation Medicine, University of Piemonte Orientale, Novara, Italy. 3. Medical Physics Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. 4. Istituto del Radio O. Alberti, Spedali Civili Hospital, Brescia University, Brescia, Italy. 5. Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. 6. Radiotherapy Oncology Department, IRCCS CROB, Rionero In Vulture, Italy. 7. Radiation Oncology Unit, Le Scotte University Hospital, Siena, Italy. 8. Radiation Oncology Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. 9. Radiotherapy Oncology Department, Sacro Cuore Hospital, Negrar-Verona, Italy. 10. Radiation Oncology Unit, Hospital Mater Salutis, Legnago, Italy. 11. Radiation Oncology Unit, Azienda USL Valle d'Aosta, Aosta, Italy. 12. Radiation Oncology Unit, Ospedale di Prato, Prato, Italy. 13. Radiation Oncology, University of Rome Tor Vergata, Rome, Italy. 14. Radiation Oncology, Department of Oncology, University of Turin, Turin, Italy.
Abstract
INTRODUCTION: A multicenter phase II study for assessing the efficacy and the toxicity of hypofractionated radiotherapy with SIB plus temozolomide in patients with glioblastoma was carried out by the Brain Study Group of the Italian Association of Radiation Oncology. METHODS: Twenty-four patients with newly diagnosed glioblastoma belonging to Recursive Partitioning Analysis classes III and IV were enrolled. The prescribed dose was 52.5 Gy in 15 fractions of 3.5 Gy and 67.5 in 15 fractions of 4.5 Gy to the SIB volume. Dose constraints for the hypofractionated schedule were provided. Radiotherapy was associated with concomitant and sequential temozolomide. RESULTS: Median overall survival (OS) was 15.1 months, while median progression-free survival (PFS) was 8.6 months. Actuarial OS at 12 months was 65.6% ± 0.09, whereas actuarial PFS at 12 months was 41.2% ± 0.10. Status of methylation of MGMT promoter resulted to be a significant prognostic factor for OS. Radiotherapy-related acute toxicity was not relevant. Three patients (12.5%) had G3 myelotoxicity that required temozolomide temporary interruption or dose reduction during the chemotherapy. However, chemotherapy was not definitely discontinued for toxicity in any case. One patient out of 24 (4.2%) developed radionecrosis that required surgical resection with no evidence of disease in the surgical specimen. CONCLUSIONS: This trial confirms that hypofractionated radiotherapy with SIB and association with temozolomide may be a reasonable and feasible option for good prognosis patients with GBM.
INTRODUCTION: A multicenter phase II study for assessing the efficacy and the toxicity of hypofractionated radiotherapy with SIB plus temozolomide in patients with glioblastoma was carried out by the Brain Study Group of the Italian Association of Radiation Oncology. METHODS: Twenty-four patients with newly diagnosed glioblastoma belonging to Recursive Partitioning Analysis classes III and IV were enrolled. The prescribed dose was 52.5 Gy in 15 fractions of 3.5 Gy and 67.5 in 15 fractions of 4.5 Gy to the SIB volume. Dose constraints for the hypofractionated schedule were provided. Radiotherapy was associated with concomitant and sequential temozolomide. RESULTS: Median overall survival (OS) was 15.1 months, while median progression-free survival (PFS) was 8.6 months. Actuarial OS at 12 months was 65.6% ± 0.09, whereas actuarial PFS at 12 months was 41.2% ± 0.10. Status of methylation of MGMT promoter resulted to be a significant prognostic factor for OS. Radiotherapy-related acute toxicity was not relevant. Three patients (12.5%) had G3 myelotoxicity that required temozolomide temporary interruption or dose reduction during the chemotherapy. However, chemotherapy was not definitely discontinued for toxicity in any case. One patient out of 24 (4.2%) developed radionecrosis that required surgical resection with no evidence of disease in the surgical specimen. CONCLUSIONS: This trial confirms that hypofractionated radiotherapy with SIB and association with temozolomide may be a reasonable and feasible option for good prognosis patients with GBM.
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