Online first
Research paper
Published online: 2024-04-25

open access

Page views 75
Article views/downloads 49
Get Citation

Connect on Social Media

Connect on Social Media

Dose escalation with simultaneous integrated boost for un-methylated multiple glioblastoma

Ory Haisraely12, Maayan Sivan1, Zvi Symon12, M. Ben-Ayun12, l. Tsvang1, J. Kraitman1, S. Dubinsky12, M. Siman-tov1, D. Benjamin1, Yaacov Lawrence12, Zvi Cohen32, Anton Whol32, Thila Kaisman-elbaz32, Alisa Taliansky24

Abstract

Background: Simultaneous involvement of multiple distinct brain regions occurs in 2–5% of all high-grade gliomas (HGG) and is associated with poor prognosis.  Whereas radiotherapy (RT) is an important and well-established treatment for high-grade glioma, the role of dose-escalated radiotherapy has yet to be established. In this case series, we report upon the dosimetry, adverse effects, and response in patients with multiple un-methylated high-grade gliomas receiving dose-escalated radiation. Materials and methods: We reviewed charts of patients with multifocal high grade glioma treated at our institution since January 2022. All patients had stereotactic biopsies after an magnetic resonance imaging (MRI) contrast-enhanced with T1, T2, FLAIR sequences and were discussed in a multidisciplinary oncology team. MGMT-positive patients received either TMZ alone or RT with TMZ and were excluded from this analysis. Un-methylated patients received dose-escalated RT without temezolamide (TMZ). Following computed tomography (CT) and MR simulation, the gros tumor volume (GTV) was delineated and prescribed 52.5 Gy in 15 fractions within the standard 40.05 Gy planning treatment volume (PTV). Treatment planning was volumetric modulated arc therapy. Results: A total of 20 patients with multiple un-methylated MGMT glioblastoma multiforme were treated with dose-escalated radiation therapy between January 2022 and June 2023. All patients completed dose escalated radiotherapy without acute adverse effects. Progression-free survival at six months was 85%, as defined by the RANO criteria. Conclusion: In this case series, we showed that un-methylated multiple high-grade glioma could be safely treated with dose escalation. Results of progression-free survival should be validated in a larger prospective clinical trial.

Article available in PDF format

View PDF Download PDF file

References

  1. Li Y, Zhang ZX, Huang GH, et al. A systematic review of multifocal and multicentric glioblastoma. J Clin Neurosci. 2021; 83: 71–76.
  2. Baro V, Cerretti G, Todoverto M, et al. Newly Diagnosed Multifocal GBM: A Monocentric Experience and Literature Review. Curr Oncol. 2022; 29(5): 3472–3488.
  3. Fleischmann DF, Schön R, Corradini S, et al. Multifocal high-grade glioma radiotherapy safety and efficacy. Radiat Oncol. 2021; 16(1): 165.
  4. Perlow HK, Palmer D. Hypofrationation dose escalated for elderly patients with a newly diagnosed glioblastoma improve survival. Int J Radiation Oncol Biol Phys. 2022; 156(2): 399–406.
  5. Niyazi M, Andratschke N, Bendszus M, et al. ESTRO-EANO guideline on target delineation and radiotherapy details for glioblastoma. Radiother Oncol. 2023; 184: 109663.
  6. Timmerman R. A Story of Hypofractionation and the Table on the Wall. Int J Radiat Oncol Biol Phys. 2022; 112(1): 4–21.
  7. Zach L, Guez D, Last D, et al. Delayed contrast extravasation MRI: a new paradigm in neuro-oncology. Neuro-Oncology. 2014; 17(3): 457–465.
  8. Liu Q, Liu Y, Li W, et al. Genetic, epigenetic, and molecular landscapes of multifocal and multicentric glioblastoma. Acta Neuropathol. 2015; 130(4): 587–597.
  9. Abbasi AW, Westerlaan HE, Holtman GA, et al. Incidence of Tumour Progression and Pseudoprogression in High-Grade Gliomas: a Systematic Review and Meta-Analysis. Clin Neuroradiol. 2018; 28(3): 401–411.
  10. Crowell C, Mata-Mbemba D, Bennett J, et al. Systematic review of diffuse hemispheric glioma, H3 G34-mutant: Outcomes and associated clinical factors. Neurooncol Adv. 2022; 4(1): vdac133.



Reports of Practical Oncology and Radiotherapy