A PHASE I DOSE ESCALATION STUDY OF HYPOFRACTIONATED IMRT FIELD-IN-FIELD BOOST FOR NEWLY DIAGNOSED GLIOBLASTOMA MULTIFORME

作者：Monjazeb Arta M^*; Ayala Deandra; Jensen Courtney; Case L Douglas; Bourland J Daniel; Ellis Thomas L; McMullen Kevin P; Chan Michael D; Tatter Stephen B; Lesser Glen J; Shaw Edward G

来源：International Journal of Radiation Oncology, Biology, Physics, 2012, 82(2): 743-748.

DOI：10.1016/j.ijrobp.2010.10.018

• Glioblastoma Multiforme
• Radiotherapy
• Dose escalation
• IMRT
• Temozolomide

Objectives: To describe the results of a Phase I dose escalation trial for newly diagnosed glioblastoma multiforme (GBM) using a hypofractionated concurrent intensity-modulated radiotherapy (IMRT) boost. %26lt;br%26gt;Methods: Twenty-one patients were enrolled between April 1999 and August 2003. Radiotherapy consisted of daily fractions of 1.8 Gy with a concurrent boost of 0.7 Gy (total 2.5 Gy daily) to a total dose of 70, 75, or 80 Gy. Concurrent chemotherapy was not permitted. Seven patients were enrolled at each dose and dose limiting toxicities were defined as irreversible Grade 3 or any Grade 4-5 acute neurotoxicity attributable to radiotherapy. %26lt;br%26gt;Results: All patients experienced Grade 1 or 2 acute toxicities. Acutely, 8 patients experienced Grade 3 and 1 patient experienced Grade 3 and 4 toxicities. Of these, only two reversible cases of otitis media were attributable to radiotherapy. No dose-limiting toxicities were encountered. Only 2 patients experienced Grade 3 delayed toxicity and there was no delayed Grade 4 toxicity. Eleven patients requiring repeat resection or biopsy were found to have viable tumor and radiation changes with no cases of radionecrosis alone. Median overall and progression-free survival for this cohort were 13.6 and 6.5 months, respectively. One- and 2-year survival rates were 57% and 19%. At recurrence, 15 patients received chemotherapy, 9 underwent resection, and 5 received radiotherapy. %26lt;br%26gt;Conclusions: Using a hypofractionated concurrent IMRT boost, we were able to safely treat patients to 80 Gy without any dose-limiting toxicity. Given that local failure still remains the predominant pattern for GBM patients, a trial of dose escalation with IMRT and temozolomide is warranted.

• 出版日期2012-2-1