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Adjuvant radiation therapy for malignant gliomas

INTRODUCTION

The malignant gliomas are rapidly progressive brain tumors that are divided into anaplastic gliomas (anaplastic astrocytoma, anaplastic oligodendroglioma, and anaplastic oligoastrocytoma) and glioblastoma (GBM) based upon their histopathologic features [1]. (See "Classification of brain tumors".)

Malignant gliomas are best managed with a combined modality approach, incorporating adjuvant postoperative radiation therapy (RT) and adjuvant chemotherapy following initial surgery. Postoperative RT is discussed in this topic.

Other topics that are covered separately include:
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References Top
  1. Walker, MD, Green, SB, Byar, DP, et al. Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med 1980; 303:1323.
  2. Andersen, AP. Postoperative irradiation of glioblastomas. Results in a randomized series. Acta Radiol Oncol Radiat Phys Biol 1978; 17:475.
  3. Walker, MD, Alexander, EJ, Hunt, WE, et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas: A cooperative clinical trial. J Neurosurg 1978; 49:333.
  4. Coffey, RJ, Lunsford, LD, Taylor, FH. Survival after stereotactic biopsy of malignant gliomas. Neurosurgery 1988; 22:465.
  5. Walker, MD, Strike, TA, Sheline, GE. An analysis of dose-effect relationship in the radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys 1979; 5:1725.
  6. Chang, CH, Horton, J, Schoenfeld, D, et al. Comparison of postoperative radiotherapy and combined postoperative radiotherapy and chemotherapy in the multidisciplinary management of malignant gliomas. A joint Radiation Therapy Oncology Group and Eastern Cooperative Oncology Group study. Cancer 1983; 52:997.
  7. Nelson, DF, Diener-West, M, Horton, J, et al. Combined modality approach to treatment of malignant gliomas--re-evaluation of RTOG 7401/ECOG 1374 with long-term follow-up: a joint study of the Radiation Therapy Oncology Group and the Eastern Cooperative Oncology Group. NCI Monogr 1988; :279.
  8. Shapiro, WR. Therapy of adult malignant brain tumors: What have clinical trials taught us? Semin Oncol 1986; 13:38.
  9. Valk, PE, Dillon, WP. Radiation injury of the brain. AJNR Am J Neuroradiol 1991; 12:45.
  10. Hochberg, FH, Pruitt, A. Assumptions in the radiotherapy of glioblastoma. Neurology 1980; 30:907.
  11. Wallner, KE, Galicich, JH, Krol, G, et al. Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 1989; 16:1405.
  12. Choucair, AK, Levin, VA, Gutin, PH, et al. Development of multiple lesions during radiation therapy and chemotherapy in patients with gliomas. J Neurosurg 1986; 65:654.
  13. Liang, BC, Thornton, AFJ, Sandler, HM, et al. Malignant astrocytomas: Focal tumor recurrence after focal external beam radiation therapy. J Neurosurg 1991; 75:559.
  14. Ten Haken, RK, Thornton, AF Jr, Sandler, HM, et al. A quantitative assessment of the addition of MRI to CT-based, 3-D treatment planning of brain tumors. Radiother Oncol 1992; 25:121.
  15. Thornton, AFJ, Hegarty, TJ, TenHaken, RK, et al. Three-dimensional treatment planning of astrocytomas: A dosimetric study of cerebral irradiation. Int J Radiat Oncol Biol Phys 1991; 20:1309.
  16. Glatstein, E, Lichter, AS, Fraass, BA, et al. The imaging revolution and radiation oncology: Use of CT, ultrasound, and NMR for localization, treatment planning and treatment delivery. Int J Radiat Oncol Biol Phys 1985; 11:299.
  17. Gross, MW, Weber, WA, Feldmann, HJ, et al. The value of F-18-fluorodeoxyglucose PET for the 3-D radiation treatment planning of malignant gliomas. Int J Radiat Oncol Biol Phys 1998; 41:989.
  18. Douglas, JG, Stelzer, KJ, Mankoff, DA, et al. [F-18]-fluorodeoxyglucose positron emission tomography for targeting radiation dose escalation for patients with glioblastoma multiforme: clinical outcomes and patterns of failure. Int J Radiat Oncol Biol Phys 2006; 64:886.
  19. Chang, J, Thakur, S, Perera, G, et al. Image-fusion of MR spectroscopic images for treatment planning of gliomas. Med Phys 2006; 33:32.
  20. Narayana, A, Yamada, J, Berry, S, et al. Intensity-modulated radiotherapy in high-grade gliomas: clinical and dosimetric results. Int J Radiat Oncol Biol Phys 2006; 64:892.
  21. Coughlin, C, Scott, C, Langer, C, et al. Phase II, two-arm RTOG trial (94-11) of bischloroethyl-nitrosourea plus accelerated hyperfractionated radiotherapy (64.0 or 70.4 Gy) based on tumor volume (> 20 or < or = 20 cm(2), respectively) in the treatment of newly-diagnosed radiosurgery-ineligible glioblastoma multiforme patients. Int J Radiat Oncol Biol Phys 2000; 48:1351.
  22. Keime-Guibert, F, Chinot, O, Taillandier, L, et al. Radiotherapy for Glioblastoma in the Elderly. N Engl J Med 2007; 356:1527.
  23. Roa, W, Brasher, PM, Bauman, G, et al. Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol 2004; 22:1583.
  24. Lutterbach, J, Ostertag, C. What is the appropriate radiotherapy protocol for older patients with newly diagnosed glioblastoma?. J Clin Oncol 2005; 23:2869.
  25. Paulino, AC, Mai, WY, Chintagumpala, M, et al. Radiation-induced malignant gliomas: is there a role for reirradiation?. Int J Radiat Oncol Biol Phys 2008; 71:1381.
  26. Shrieve, DC, Alexander, E 3rd, Black, PM, et al. Treatment of patients with primary glioblastoma multiforme with standard postoperative radiotherapy and radiosurgical boost: prognostic factors and long-term outcome. J Neurosurg 1999; 90:72.
  27. Prisco, FE, Weltman, E, de Hanriot, RM, Brandt, RA. Radiosurgical boost for primary high-grade gliomas. J Neurooncol 2002; 57:151.
  28. Masciopinto, JE, Levin, AB, Mehta, MP, et al. Stereotactic radiosurgery for glioblastoma: A final report of 31 patients. J Neurosurg 1995; 82:530.
  29. Nwokedi, EC, DiBiase, SJ, Jabbour, S, et al. Gamma knife stereotactic radiosurgery for patients with glioblastoma multiforme. Neurosurgery 2002; 50:41.
  30. Cardinale, R, Won, M, Choucair, A, et al. A phase II trial of accelerated radiotherapy using weekly stereotactic conformal boost for supratentorial glioblastoma multiforme: RTOG 0023. Int J Radiat Oncol Biol Phys 2006; 65:1422.
  31. Curran, WJ, Scott, CB, Weinstein, AS, et al. Survival comparison of radiosurgery-eligible and - ineligible malignant glioma patients treated with hyperfractionated radiation therapy and carmustine: A report of Radiation Therapy Oncology Group 83-02. J Clin Oncol 1993; 11:857.
  32. Tsao, MN, Mehta, MP, Whelan, TJ, et al. The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for malignant glioma. Int J Radiat Oncol Biol Phys 2005; 63:47.
  33. Souhami, L, Seiferheld, MD, Brachman, D, et al. 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. Int J Radiat Oncol Biol Phys 2004; 60:853.
  34. Marin, LA, Smith, CE, Langston, MY, et al. Response of glioblastoma cell lines to low dose rate irradiation. Int J Radiat Oncol Biol Phys 1991; 21:397.
  35. Sneed, PK, Lamborn, KR, Larson, DA, et al. Demonstration of brachytherapy boost dose-response relationships in glioblastoma multiforme. Int J Radiat Oncol Biol Phys 1996; 35:37.
  36. Koot, RW, Maarouf, M, Hulshof, MC, et al. Brachytherapy: Results of two different therapy strategies for patients with primary glioblastoma multiforme. Cancer 2000; 88:2796.
  37. Selker, RG, Shapiro, WR, Burger, P, et al. The Brain Tumor Cooperative Group NIH Trial 87-01: a randomized comparison of surgery, external radiotherapy, and carmustine versus surgery, interstitial radiotherapy boost, external radiation therapy, and carmustine. Neurosurgery 2002; 51:343.
  38. Laperriere, NJ, Leung, PM, McKenzie, S, et al. Randomized study of brachytherapy in the initial management of patients with malignant astrocytoma. Int J Radiat Oncol Biol Phys 1998; 41:1005.
  39. Wilson, CB, Larson, DA, Gutin, PH. Radiosurgery: A new application? J Clin Oncol 1992; 10:1373.
  40. Cohen, L, Awschalom, M. Fast neutron radiation therapy. Annu Rev Biophys Bioeng 1982; 11:359.
  41. Cohen, L, Hendrickson, FR, Kurup, PD, et al. Clinical evaluation of neutron beam therapy. Current results and prospects, 1983. Cancer 1985; 55:10.
  42. Griffin, TW, Davis, R, Laramore, G, et al. Fast neutron radiation therapy for glioblastoma multiforme. Am J Clin Oncol 1983; 6:661.
  43. Castro, JR, Saunders, WM, Austin-Seymour, MM, et al. A phase I-II trial of heavy charged particle irradiation of malignant glioma of the brain: A Northern California Oncology Group study. Int J Radiat Oncol Biol Phys 1985; 11:1795.
  44. Castro, JR, Phillips, TL, Prados, M, et al. Neon heavy charged particle radiotherapy of glioblastoma of the brain. Int J Radiat Oncol Biol Phys 1997; 38:257.
  45. Fitzek, MM, Thornton, AF, Rabinov, JD, et al. Accelerated fractionated proton/photon irradiation to 90 cobalt Gray equivalent for glioblastoma multiforme: results of a phase II prospective trial. J Neurosurg 1999; 91:251.
  46. Huncharek, M. Meta-analytic re-evaluation of misonidazole in the treatment of high grade astrocytoma. Anticancer Res 1998; 18:1935.
  47. Prados, MD, Seiferheld, W, Sandler, HM, et al. Phase III randomized study of radiotherapy plus procarbazine, lomustine, and vincristine with or without BUdR for treatment of anaplastic astrocytoma: final report of RTOG 9404. Int J Radiat Oncol Biol Phys 2004; 58:1147.
  48. Prados, MD, Wara, WM, Sneed, PK, et al. Phase III trial of accelerated hyperfractionation with or without difluromethylornithine (DFMO) versus standard fractionated radiotherapy with or without DFMO for newly diagnosed patients with glioblastoma multiforme. Int J Radiat Oncol Biol Phys 2001; 49:71.
  49. Fadul, CE, Wen, PY, Kim, L, Olson, JJ. Cytotoxic chemotherapeutic management of newly diagnosed glioblastoma multiforme. J Neurooncol 2008; 89:339.
  50. Buatti, J, Ryken, TC, Smith, MC, et al. Radiation therapy of pathologically confirmed newly diagnosed glioblastoma in adults. J Neurooncol 2008; 89:313.
  51. Ryken, TC, Frankel, B, Julien, T, Olson, JJ. Surgical management of newly diagnosed glioblastoma in adults: role of cytoreductive surgery. J Neurooncol 2008; 89:271.
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