INTRODUCTION:Maximal safe surgical resection followed by adjuvant chemoradiation has been standard for newly diagnosed glioblastoma multiforme (GBM). Hypofractionated accelerated radiotherapy (HART) has the potential to improve outcome as it reduces the overall treatment time and increases the biological effective dose. METHODS:Between October 2011 and July 2017, a total of 89 newly diagnosed GBM patients were randomized to conventional fractionated radiotherapy (CRT) or HART. Radiotherapy was delivered in all patients with a three-dimensional conformal radiotherapy technique in CRT arm (60 Gy in 30 fractions over 6 weeks @ 2 Gy/per fraction) or simultaneous integrated boost intensity modulated radiotherapy in HART arm (60 Gy in 20 fractions over 4 weeks @ 3 Gy/per fraction to high-risk planning target volume (PTV) and 50 Gy in 20 fractions over 4 weeks @ 2.5 Gy/per fraction to low-risk PTV). The primary endpoint of the trial was overall survival (OS). RESULTS: After a median follow-up of 11.4 months (Range: 2.9-42.5 months), 26 patients died and 39 patients had progression of the disease. Median OS for the entire cohort was 23.4 months. Median OS in the CRT and HART arms were 18.07 months (95% CI 14.52-NR) and 25.18 months (95% CI 12.89-NR) respectively, p = 0.3. Median progression free survival (PFS) for the entire cohort was 13.5 months (Range: 11.7-15.7 months). In multivariate analysis patients younger than 40 years of age, patients with a gross total resection of tumor and a mutated IDH-1 had significantly better OS. PFS was significantly better for patients with a gross total resection of tumor and a mutated IDH-1. All patients included in the trial completed the planned course of radiation. Only two patients required hospital admission for features of raised intracranial tension. One patient in the HART arm required treatment interruption. CONCLUSION:HART is comparable to CRT in terms of survival outcome. HART arm had no excess treatment interruption and minimal toxicity. Dose escalation, reduction in overall treatment time, is the advantages with use of HART.
RCT Entities:
INTRODUCTION: Maximal safe surgical resection followed by adjuvant chemoradiation has been standard for newly diagnosed glioblastoma multiforme (GBM). Hypofractionated accelerated radiotherapy (HART) has the potential to improve outcome as it reduces the overall treatment time and increases the biological effective dose. METHODS: Between October 2011 and July 2017, a total of 89 newly diagnosed GBM patients were randomized to conventional fractionated radiotherapy (CRT) or HART. Radiotherapy was delivered in all patients with a three-dimensional conformal radiotherapy technique in CRT arm (60 Gy in 30 fractions over 6 weeks @ 2 Gy/per fraction) or simultaneous integrated boost intensity modulated radiotherapy in HART arm (60 Gy in 20 fractions over 4 weeks @ 3 Gy/per fraction to high-risk planning target volume (PTV) and 50 Gy in 20 fractions over 4 weeks @ 2.5 Gy/per fraction to low-risk PTV). The primary endpoint of the trial was overall survival (OS). RESULTS: After a median follow-up of 11.4 months (Range: 2.9-42.5 months), 26 patients died and 39 patients had progression of the disease. Median OS for the entire cohort was 23.4 months. Median OS in the CRT and HART arms were 18.07 months (95% CI 14.52-NR) and 25.18 months (95% CI 12.89-NR) respectively, p = 0.3. Median progression free survival (PFS) for the entire cohort was 13.5 months (Range: 11.7-15.7 months). In multivariate analysis patients younger than 40 years of age, patients with a gross total resection of tumor and a mutated IDH-1 had significantly better OS. PFS was significantly better for patients with a gross total resection of tumor and a mutated IDH-1. All patients included in the trial completed the planned course of radiation. Only two patients required hospital admission for features of raised intracranial tension. One patient in the HART arm required treatment interruption. CONCLUSION: HART is comparable to CRT in terms of survival outcome. HART arm had no excess treatment interruption and minimal toxicity. Dose escalation, reduction in overall treatment time, is the advantages with use of HART.
Authors: Olivier L Chinot; Wolfgang Wick; Warren Mason; Roger Henriksson; Frank Saran; Ryo Nishikawa; Antoine F Carpentier; Khe Hoang-Xuan; Petr Kavan; Dana Cernea; Alba A Brandes; Magalie Hilton; Lauren Abrey; Timothy Cloughesy Journal: N Engl J Med Date: 2014-02-20 Impact factor: 91.245
Authors: Mark R Gilbert; James J Dignam; Terri S Armstrong; Jeffrey S Wefel; Deborah T Blumenthal; Michael A Vogelbaum; Howard Colman; Arnab Chakravarti; Stephanie Pugh; Minhee Won; Robert Jeraj; Paul D Brown; Kurt A Jaeckle; David Schiff; Volker W Stieber; David G Brachman; Maria Werner-Wasik; Ivo W Tremont-Lukats; Erik P Sulman; Kenneth D Aldape; Walter J Curran; Minesh P Mehta Journal: N Engl J Med Date: 2014-02-20 Impact factor: 91.245
Authors: Christopher A Barker; Andrew J Bishop; Maria Chang; Kathryn Beal; Timothy A Chan Journal: Int J Radiat Oncol Biol Phys Date: 2013-03-20 Impact factor: 7.038
Authors: Mark R Gilbert; Meihua Wang; Kenneth D Aldape; Roger Stupp; Monika E Hegi; Kurt A Jaeckle; Terri S Armstrong; Jeffrey S Wefel; Minhee Won; Deborah T Blumenthal; Anita Mahajan; Christopher J Schultz; Sara Erridge; Brigitta Baumert; Kristen I Hopkins; Tzahala Tzuk-Shina; Paul D Brown; Arnab Chakravarti; Walter J Curran; Minesh P Mehta Journal: J Clin Oncol Date: 2013-10-07 Impact factor: 44.544
Authors: Guillaume Louvel; Philippe Metellus; Georges Noel; Sophie Peeters; Jacques Guyotat; Julien Duntze; Pierre-Jean Le Reste; Phong Dam Hieu; Thierry Faillot; Fabien Litre; Nicolas Desse; Antoine Petit; Evelyne Emery; Jimmy Voirin; Johann Peltier; François Caire; Jean-Rodolphe Vignes; Jean-Luc Barat; Olivier Langlois; Philippe Menei; Sarah N Dumont; Marc Zanello; Edouard Dezamis; Frédéric Dhermain; Johan Pallud Journal: Radiother Oncol Date: 2016-01-11 Impact factor: 6.280
Authors: Roger Stupp; Monika E Hegi; Thierry Gorlia; Sara C Erridge; James Perry; Yong-Kil Hong; Kenneth D Aldape; Benoit Lhermitte; Torsten Pietsch; Danica Grujicic; Joachim Peter Steinbach; Wolfgang Wick; Rafał Tarnawski; Do-Hyun Nam; Peter Hau; Astrid Weyerbrock; Martin J B Taphoorn; Chiung-Chyi Shen; Nalini Rao; László Thurzo; Ulrich Herrlinger; Tejpal Gupta; Rolf-Dieter Kortmann; Krystyna Adamska; Catherine McBain; Alba A Brandes; Joerg Christian Tonn; Oliver Schnell; Thomas Wiegel; Chae-Yong Kim; Louis Burt Nabors; David A Reardon; Martin J van den Bent; Christine Hicking; Andriy Markivskyy; Martin Picard; Michael Weller Journal: Lancet Oncol Date: 2014-08-19 Impact factor: 41.316
Authors: Niha Beig; Kaustav Bera; Prateek Prasanna; Jacob Antunes; Ramon Correa; Salendra Singh; Anas Saeed Bamashmos; Marwa Ismail; Nathaniel Braman; Ruchika Verma; Virginia B Hill; Volodymyr Statsevych; Manmeet S Ahluwalia; Vinay Varadan; Anant Madabhushi; Pallavi Tiwari Journal: Clin Cancer Res Date: 2020-02-20 Impact factor: 12.531