Intensity-modulated radiotherapy in high-grade gliomas: Clinical and dosimetric results Journal Article
| Authors: | Narayana, A.; Yamada, J.; Berry, S.; Shah, P.; Hunt, M.; Gutin, P. H.; Leibel, S. A. |
| Article Title: | Intensity-modulated radiotherapy in high-grade gliomas: Clinical and dosimetric results |
| Abstract: | Purpose: To report preliminary clinical and dosimetric data from intensity-modulated radiotherapy (IMRT) for malignant gliomas. Methods and Materials: Fifty-eight consecutive high-grade gliomas were treated between January 2001 and December 2003 with dynamic multileaf collimator IMRT, planned with the inverse approach. A dose of 59.4-60 Gy at 1.8-2.0 Gy per fraction was delivered. A total of three to five noncoplanar beams were used to cover at least 95% of the target volume with the prescription isodose line. Glioblastoma accounted for 70% of the cases, and anaplastic oligodendroglioma histology (pure or mixed) was seen in 15% of the cases. Surgery consisted of biopsy only in 26% of the patients, and 80% received adjuvant chemotherapy. Results: With a median follow-up of 24 months, 85% of the patients have relapsed. The median progression-free survival time for anaplastic astrocytoma and glioblastoma histology was 5.6 and 2.5 months, respectively. The overall survival time for anaplastic glioma and glioblastoma was 36 and 9 months, respectively. Ninety-six percent of the recurrences were local. No Grade IV/V late neurologic toxicities were noted. A comparative dosimetric analysis revealed that regardless of tumor location, IMRT did not significantly improve target coverage compared with three-dimensional planning. However, IMRT resulted in a decreased maximum dose to the spinal cord, optic nerves, and eye by 16%, 7%, and 15%, respectively, owing to its improved dose conformality. The mean brainstem dose also decreased by 7%. Intensity-modulated radiotherapy delivered with a limited number of beams did not result in an increased dose to the normal brain. Conclusions: It is unlikely that IMRT will improve local control in high-grade gliomas without further dose escalation compared with conventional radiotherapy. However, it might result in decreased late toxicities associated with radiotherapy. © 2006 Elsevier Inc. |
| Keywords: | adult; cancer survival; controlled study; human tissue; aged; aged, 80 and over; middle aged; cancer surgery; retrospective studies; major clinical study; cancer recurrence; intensity modulated radiation therapy; cancer radiotherapy; disease free survival; radiation dose; follow up; glioma; brain neoplasms; cancer grading; tumor localization; neoplasm recurrence, local; radiotherapy dosage; radiotherapy; tumor biopsy; biopsy; histology; survival time; clinical study; brain; intensity-modulated radiotherapy; tumors; radiotherapy, intensity-modulated; dosimetry; disease progression; spinal cord; glioblastoma; cancer relapse; oligodendroglioma; collimator; optic nerve; disease control; computer assisted radiotherapy; neurologic disease; brain stem; anaplastic carcinoma; eye; gliomas; optical collimators |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 64 |
| Issue: | 3 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2006-03-01 |
| Start Page: | 892 |
| End Page: | 897 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2005.05.067 |
| PUBMED: | 16458777 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 45" - "Export Date: 4 June 2012" - "CODEN: IOBPD" - "Source: Scopus" |
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