Hypofractionated Radiotherapy Using Simultaneous Integrated Boost Technique with Concurrent and Adjuvant Temozolomide for Glioblastoma

Main Article Content

Manal M. S. Elghareeb
Hanan Ahmed Wahba
Ahmed M. El- Demeri
Mohamed Elashry
Rasha Abd El Ghany Khedr

Abstract

Aim: This study was conducted to assess the safety and efficacy of postoperative hypofractionated radiotherapy (HRT) using simultaneous integrated boost (SIB) technique for glioblastoma (GBM) compared to conventional radiotherapy (CRT).

Study Design: This was a prospective study with historical control arm.

Place and Duration of the Study: Department of Clinical Oncology and Nuclear Medicine, Mansoura University Hospital, Mansoura, Egypt, between May 2017 and June 2019.

Methods: The intervention (HRT) group included 30 patients who received 3D conformal HRT with SIB using field in field (FIF) technique to deliver a differential radiation dose to different targets. Planning target volume 60 (PTV60) includes the gross target volume (GTV) plus a 5-mm margin, and PTV45 includes the GTV plus a 15-mm margin. PTV60 will receive 60 Gy in 20 fractions, and PTV45 will receive 45 Gy in the same 20 fractions (one fraction daily and 5 days per week).The CRT group included 30 patients who received 3D conformal CRT with total dose 60 Gy in 2-Gy fractions delivered over 6 weeks. Both groups was planned to receive concurrent and adjuvant temozolamide.

Results: The median PFS was 10 months in both groups. The median OS was 13 months in HRT group versus 12 months in CRT group which is statistically non significant. The toxicities were mild and acceptable. Performance status and adjuvant temozolamide were significant predictors that affect the overall survival.

Conclusions: HRT with SIB using 3D conformal RTH with (FIF) technique in patients with GBM is a feasible and safe treatment and its results is comparable to the conventional radiotherapy.

Keywords:
Glioblastoma, simultaneous integrated boost, hypofractionated radiotherapy, temozolomide, toxicity, efficacy.

Article Details

How to Cite
Elghareeb, M. M. S., Wahba, H. A., Demeri, A. M. E.-, Elashry, M., & Khedr, R. A. E. G. (2020). Hypofractionated Radiotherapy Using Simultaneous Integrated Boost Technique with Concurrent and Adjuvant Temozolomide for Glioblastoma. Journal of Cancer and Tumor International, 10(4), 16-23. https://doi.org/10.9734/jcti/2020/v10i430134
Section
Original Research Article

References

Koshy, Matthew et al. Improved survival time trends for glioblastoma using the SEER 17 population-based registries. Journal of Neuro-oncology. 2012;107(1): 207-12. DOI:10.1007/s11060-011-0738-7

Davis, Mary. Glioblastoma: overview of disease and treatment. Clinical Journal of Oncology Nursing. 2016;20(5):S2-S8. Oncology Nursing Society (ONS). DOI:10.1188/16.cjon.s1.2-8.

Cabrera, Alvin R et al. Radiation therapy for glioblastoma: Executive summary of an American society for radiation oncology evidence-based clinical practice guideline. Practical Radiation Oncology. 2016;6(4): 217-225. DOI:10.1016/j.prro.2016.03.007

Shieh, Li-Tsun et al. Survival of glioblastoma treated with a moderately escalated radiation dose-Results of a retrospective analysis. PloS one. 2020;15(5):e0233188. DOI:10.1371/journal.pone.0233188

Chen, Changhu et al. Phase I trial of hypofractionated intensity-modulated radiotherapy with temozolomide chemo-therapy for patients with newly diagnosed glioblastoma multiforme. International Journal of Radiation Oncology, Biology, Physics. 2011;81(4):1066-74. DOI:10.1016/j.ijrobp.2010.07.021

Jastaniyah, Noha et al. Phase I study of hypofractionated intensity modulated radiation therapy with concurrent and adjuvant temozolomide in patients with glioblastoma multiforme. Radiation Oncology (London, England). 2013;8(38). DOI:10.1186/1748-717X-8-38.

Shenouda, George et al. A Phase 2 Trial of Neoadjuvant Temozolomide Followed by Hypofractionated Accelerated Radiation Therapy With Concurrent and Adjuvant Temozolomide for Patients With Glioblastoma. International Journal of Radiation Oncology, Biology, Physics. 2017;97(3):487-494. DOI:10.1016/j.ijrobp.2016.11.006

Panet-Raymond, Valerie et al. Accelerated hypofractionated intensity-modulated radiotherapy with concurrent and adjuvant temozolomide for patients with glioblastoma multiforme: a safety and efficacy analysis. International Journal of Radiation Oncology, Biology, Physics. 2009;73(2):473-8. DOI:10.1016/j.ijrobp.2008.04.030

Cho, Kwan Ho et al. Simultaneous integrated boost intensity-modulated radiotherapy in patients with high-grade gliomas. International Journal of Radiation Oncology, Biology, Physics. 2010;78(2): 390-7. DOI:10.1016/j.ijrobp.2009.08.029

Sultanem, Khalil et al. The use of hypofractionated intensity-modulated irradiation in the treatment of glioblastoma multiforme: Preliminary results of a prospective trial. International Journal of Radiation Oncology, Biology, Physics. 2004;58(1):247-52. DOI: 10.1016/s0360-3016(03)00819-8

Zhong, Liangzhi et al. Efficacy of moderately hypofractionated simultaneous integrated boost intensity-modulated radiotherapy combined with temozolomide for the postoperative treatment of glioblastoma multiforme: A single-institution experience. Radiation oncology (London, England). 2019;14(1):104. DOI: 10.1186/s13014-019-1305-1

Mallick, Supriya et al. Hypofractionated accelerated radiotherapy (HART) with concurrent and adjuvant temozolomide in newly diagnosed glioblastoma: A phase II randomized trial (HART-GBM trial). Journal of Neuro-Oncology. 2018;140(1): 75-82. DOI:10.1007/s11060-018-2932-3

Liao, Guixiang et al. Efficacy and safety of hypofractionated radiotherapy for the treatment of newly diagnosed glioblastoma multiforme: A systematic review and meta-analysis. Frontiers in Oncology. 2019;9:1017. DOI: 10.3389/fonc.2019.01017

Trone, Jane-Chloe et al. Survival after hypofractionation in glioblastoma: A systematic review and meta-analysis. Radiation Oncology (London, England). 2020;15(1):145. DOI: 10.1186/s13014-020-01584-6