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Hypofractionated intensity-modulated radiotherapy using simultaneous integrated boost technique with concurrent and adjuvant temozolomide for glioblastoma

Abstract

Aims and background. We assessed the therapeutic efficacy of combined hypofractionated intensity-modulated radiotherapy with temozolomide in patients with primary glioblastoma.
Methods and study design. Thirty-nine patients with histologically confirmed glioblastoma were accrued. Using the simultaneous integrated boost technique, a dose of 50 Gy in 5-Gy fractions was applied to the gross tumor volume, together with 40 Gy in 4-Gy fractions and 30 Gy in 3-Gy fractions to the 1- and 2-cm margins from the gross tumor volume, respectively. Patients were also treated with concurrent temozolomide during intensity-modulated radiotherapy, followed by six cycles of adjuvant temozolomide.
Results. Median follow-up was 16.8 months (range, 4.3-54.3). Tumor progression was observed in 28 patients (71.8%), and the median time to progression was 6.8 months. Median survival was 16.8 months, and it was affected significantly by the extent of surgery. During adjuvant temozolomide treatment, 3 patients (9.7%) developed grade 3-4 hematologic or hepatic toxicity. Radiation necrosis developed in 7 patients (17.9%) and massive necrosis, requiring emergency surgery, in 1 patient (2.6%).
Conclusions. The regimen of hypofractionated intensity-modulated radiotherapy with temozolomide showed a relatively good outcome in patients with glioblastoma. Further studies are required to define the optimal fraction size for glioblastoma using this highly sophisticated radiation technique.

Tumori 2013; 99(4): 480 - 487

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.1700/1361.15098

Authors

Sang Min Yoon, Jeong Hoon Kim, Sang Joon Kim, Shin Kwang Khang, Seong Soo Shin, Young Hyun Cho, Eunjin Jwa, Jin-hong Park, Seung Do Ahn

Article History

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Authors

  • Yoon, Sang Min [PubMed] [Google Scholar]
    Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • Kim, Jeong Hoon [PubMed] [Google Scholar]
    Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • Kim, Sang Joon [PubMed] [Google Scholar]
    Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • Khang, Shin Kwang [PubMed] [Google Scholar]
    Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • Shin, Seong Soo [PubMed] [Google Scholar]
    Department of Radiation Oncology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon, Republic of Korea
  • Cho, Young Hyun [PubMed] [Google Scholar]
    Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • Jwa, Eunjin [PubMed] [Google Scholar]
    Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • Park, Jin-hong [PubMed] [Google Scholar]
    Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • Ahn, Seung Do [PubMed] [Google Scholar]
    Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

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