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By Alessandro Franciscon doctor
Roger Stupp, Sophie Taillibert, Andrew Kanner, William Read, David Steinberg, Benoit Lhermitte, Steven Toms, Ahmed Idbaih, Manmeet S. Ahluwalia, Karen Fink, Francesco Di Meco, Frank Lieberman, Jay-Jiguang Zhu, Giuseppe Stragliotto, David Tran, Steven Brem, Andreas Hottinger, Eilon D. Kirson, Gitit Lavy-Shahaf, Uri Weinberg, Chae-Yong Kim, Sun-Ha Paek, Garth Nicholas, Jordi Bruna, Hal Hirte, Michael Weller, Yoram Palti, Monika E. Hegi, Zvi Ram
Importance: Tumor-treating fields (TTFields) is an antimitotic treatment modality that interferes with glioblastoma cell division and organelle assembly by delivering low-intensity alternating electric fields to the tumor. Objective: To investigate whether TTFields improves progression-free and overall survival of patients with glioblastoma, a fatal disease that commonly recurs at the initial tumor site or in the central nervous system. Design, Setting, and Participants: In this randomized, open-label trial, 695 patients with glioblastoma whose tumor was resected or biopsied and had completed concomitant radiochemotherapy (median time from diagnosis to randomization, 3...
December 19, 2017: JAMA: the Journal of the American Medical Association
M Mehta, P Wen, R Nishikawa, D Reardon, K Peters
Since 2005, the standard of care for patients with newly diagnosed glioblastoma (GBM) has consisted of maximal resection followed by radiotherapy plus daily temozolomide (TMZ), followed by maintenance TMZ. In patients selected for clinical trials, median overall survival (OS) and progression-free survival (PFS) with this regimen is 15-17 months and 6-7 months, respectively. There have been various, largely unsuccessful attempts to improve on this standard of care. With the FDA approval of the tumor-treating fields (TTFields) device, Optune, for recurrent GBM (2011), and the more recent EF-14 interim trial results and approval for newly diagnosed GBM patients, several questions have arisen...
March 2017: Critical Reviews in Oncology/hematology
Francesco Pignatti, Martin van den Bent, Desmond Curran, Channa Debruyne, Richard Sylvester, Patrick Therasse, Denes Afra, Philippe Cornu, Michel Bolla, Charles Vecht, Abul B M F Karim
PURPOSE: To identify prognostic factors for survival in adult patients with cerebral low-grade glioma (LGG), to derive a prognostic scoring system, and to validate results using an independent data set. PATIENTS AND METHODS: European Organization for Research and Treatment of Cancer (EORTC) trial 22844 and EORTC trial 22845 are the largest phase III trials ever carried out in adult patients with LGG. The trials were designed to investigate the dosage and timing of postoperative radiotherapy in LGG...
April 15, 2002: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Jan C Buckner, Edward G Shaw, Stephanie L Pugh, Arnab Chakravarti, Mark R Gilbert, Geoffrey R Barger, Stephen Coons, Peter Ricci, Dennis Bullard, Paul D Brown, Keith Stelzer, David Brachman, John H Suh, Christopher J Schultz, Jean-Paul Bahary, Barbara J Fisher, Harold Kim, Albert D Murtha, Erica H Bell, Minhee Won, Minesh P Mehta, Walter J Curran
BACKGROUND: Grade 2 gliomas occur most commonly in young adults and cause progressive neurologic deterioration and premature death. Early results of this trial showed that treatment with procarbazine, lomustine (also called CCNU), and vincristine after radiation therapy at the time of initial diagnosis resulted in longer progression-free survival, but not overall survival, than radiation therapy alone. We now report the long-term results. METHODS: We included patients with grade 2 astrocytoma, oligoastrocytoma, or oligodendroglioma who were younger than 40 years of age and had undergone subtotal resection or biopsy or who were 40 years of age or older and had undergone biopsy or resection of any of the tumor...
April 7, 2016: New England Journal of Medicine
Douglas Guedes de Castro, Juliana Matiello, Wilson Roa, Sunita Ghosh, Lucyna Kepka, Narendra Kumar, Valery Sinaika, Darejan Lomidze, Dalenda Hentati, Eduardo Rosenblatt, Elena Fidarova
PURPOSE: To perform a subset analysis of survival outcomes in elderly patients with glioblastoma from a randomized phase 3 trial comparing 2 short-course radiation therapy (RT) regimens in elderly and/or frail patients. METHODS AND MATERIALS: The original trial population included elderly and/or frail patients with a diagnosis of glioblastoma. Patients joined the phase 3, randomized, multicenter, prospective, noninferiority trial; were assigned to 1 of 2 groups in a 1:1 ratio, either short-course RT (25 Gy in 5 fractions, arm 1) or commonly used RT (40 Gy in 15 fractions, arm 2); and were stratified by age (<65 years and ≥65 years), Karnofsky Performance Status (KPS), and extent of surgery...
July 15, 2017: International Journal of Radiation Oncology, Biology, Physics
Michael Weller, Martin van den Bent, Jörg C Tonn, Roger Stupp, Matthias Preusser, Elizabeth Cohen-Jonathan-Moyal, Roger Henriksson, Emilie Le Rhun, Carmen Balana, Olivier Chinot, Martin Bendszus, Jaap C Reijneveld, Frederick Dhermain, Pim French, Christine Marosi, Colin Watts, Ingela Oberg, Geoffrey Pilkington, Brigitta G Baumert, Martin J B Taphoorn, Monika Hegi, Manfred Westphal, Guido Reifenberger, Riccardo Soffietti, Wolfgang Wick
The European Association for Neuro-Oncology guideline provides recommendations for the clinical care of adult patients with astrocytic and oligodendroglial gliomas, including glioblastomas. The guideline is based on the 2016 WHO classification of tumours of the central nervous system and on scientific developments since the 2014 guideline. The recommendations focus on pathological and radiological diagnostics, and the main treatment modalities of surgery, radiotherapy, and pharmacotherapy. In this guideline we have also integrated the results from contemporary clinical trials that have changed clinical practice...
June 2017: Lancet Oncology
George Shenouda, Luis Souhami, Kevin Petrecca, Scott Owen, Valerie Panet-Raymond, Marie-Christine Guiot, Andrea Gomez Corredor, Bassam Abdulkarim
PURPOSE: We performed a phase 2 trial of neoadjuvant temozolomide (TMZ), followed by hypofractionated accelerated radiation therapy (HART) with concurrent TMZ, and adjuvant TMZ in patients with newly diagnosed glioblastoma to determine whether neoadjuvant TMZ would safely improve outcomes in this group of patients prior to subsequent cytotoxic therapy. METHODS AND MATERIALS: Adult patients with newly diagnosed glioblastoma and a Karnofsky Performance Status >60 were eligible...
March 1, 2017: International Journal of Radiation Oncology, Biology, Physics
Roger Stupp, Warren P Mason, Martin J van den Bent, Michael Weller, Barbara Fisher, Martin J B Taphoorn, Karl Belanger, Alba A Brandes, Christine Marosi, Ulrich Bogdahn, Jürgen Curschmann, Robert C Janzer, Samuel K Ludwin, Thierry Gorlia, Anouk Allgeier, Denis Lacombe, J Gregory Cairncross, Elizabeth Eisenhauer, René O Mirimanoff
BACKGROUND: Glioblastoma, the most common primary brain tumor in adults, is usually rapidly fatal. The current standard of care for newly diagnosed glioblastoma is surgical resection to the extent feasible, followed by adjuvant radiotherapy. In this trial we compared radiotherapy alone with radiotherapy plus temozolomide, given concomitantly with and after radiotherapy, in terms of efficacy and safety. METHODS: Patients with newly diagnosed, histologically confirmed glioblastoma were randomly assigned to receive radiotherapy alone (fractionated focal irradiation in daily fractions of 2 Gy given 5 days per week for 6 weeks, for a total of 60 Gy) or radiotherapy plus continuous daily temozolomide (75 mg per square meter of body-surface area per day, 7 days per week from the first to the last day of radiotherapy), followed by six cycles of adjuvant temozolomide (150 to 200 mg per square meter for 5 days during each 28-day cycle)...
March 10, 2005: New England Journal of Medicine
Nimish A Mohile
Glioblastoma, a WHO grade IV astrocytoma, is the most common primary malignant brain tumor in adults. It is characterized by molecular heterogeneity and aggressive behavior. Glioblastoma is almost always incurable and most older patients survive less than 6 months. Supportive care with steroids and anti-epileptic drugs is critical to improving and maintain quality of life. Young age, good performance status and methylation of the methyl guanyl methyl transferase promoter are important positive prognostic factors...
January 2016: Journal of Geriatric Oncology
Michelle Ferguson, George Rodrigues, Jeffrey Cao, Glenn Bauman
The incidence of glioblastoma (GBM) has been increasing over the past several decades with majority of this increase occurring in patients older than 70 years. In spite of the growing body of evidence in this area, it is still unclear as to the optimal management of elderly patients with GBM. The elderly are a heterogeneous population with a range of comorbid conditions, and functional, cognitive, and physiological changes, and ideally treatment decisions should be made in the context of a comprehensive geriatric assessment...
October 2014: Seminars in Radiation Oncology
Maximilian Niyazi, Michael Brada, Anthony J Chalmers, Stephanie E Combs, Sara C Erridge, Alba Fiorentino, Anca L Grosu, Frank J Lagerwaard, Giuseppe Minniti, René-Olivier Mirimanoff, Umberto Ricardi, Susan C Short, Damien C Weber, Claus Belka
BACKGROUND AND PURPOSE: Target delineation in glioblastoma (GBM) varies substantially between different institutions and several consensus statements are available. This guideline aims to develop a joint European consensus on the delineation of the clinical target volume in patients with a glioblastoma (GBM). MATERIAL AND METHODS: A literature search was conducted in PubMed that evaluated adults with GBM. Both MeSH terms and text words were used and the following search strategy was applied: ("Glioblastoma/radiotherapy" [MeSH] OR "glioblastoma" OR "malignant glioma" OR high-grade glioma) AND ((delineation) OR (target volume) OR (CTV) OR (PTV) OR (margin) OR (recurrence pattern) OR (contouring) OR (organs at risk))...
January 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Shannon Fogh, Michael Wahl, Mekhail Anwar, Daphne Haas-Kogan, Jennifer L Clarke, Penny K Sneed
Standard treatment for Glioblastoma Multiforme (GBM) consists of a combination of chemotherapy and radiation therapy followed by adjuvant chemotherapy. While the optimal dose of radiation therapy has been established, significant variability in volume of tissue irradiated exists. In this article we review the current guidelines, patterns of care, patterns of failure, imaging advances and toxicity related to radiation therapy volumes in the treatment of GBM.
October 2014: Seminars in Radiation Oncology
John P Kirkpatrick, John H Sampson
In almost all patients, malignant glioma recurs following initial treatment with maximal safe resection, conformal radiotherapy, and temozolomide. This review describes the many options for treatment of recurrent malignant gliomas, including reoperation, alternating electric field therapy, chemotherapy, stereotactic radiotherapy or radiosurgery, or some combination of these modalities, presenting the evidence for each approach. No standard of care has been established, though the antiangiogenic agent, bevacizumab; stereotactic radiotherapy or radiosurgery; and, perhaps, combined treatment with these 2 modalities appear to offer modest benefits over other approaches...
October 2014: Seminars in Radiation Oncology
Nadia N Laack, Jann N Sarkaria, Jan C Buckner
Treatment of newly diagnosed or suspected low-grade glioma (LGG) is one of the most controversial areas in neuro-oncology. The heterogeneity of these tumors, concern regarding morbidity of treatment, and absence of proven overall survival benefit from any known treatment have resulted in a lack of consensus regarding the timing and extent of surgery, timing of radiotherapy (RT), and role of chemotherapy. The long-term results of Radiation Therapy Oncology Group (RTOG) 9802, a phase III randomized trial comparing RT alone with RT and 6 cycles of adjuvant procarbazine, CCNU, vincristine (PCV), demonstrated an unprecedented 5...
July 2015: Seminars in Radiation Oncology
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