Evidensrapport 1 - Scribd
(2011). Dose constraints for normal tissues were not published in the randomized trial by Roa et al. of 40 Gy in 15 fractions vs. 60 Gy in 30 fractions for elderly patients with glioblastoma (Journal of Clinical Oncology, 2004). Phase 1/2 Trial of 5-Fraction Stereotactic Radiosurgery With 5-mm Margins With Concurrent and Adjuvant Temozolomide in Newly Diagnosed Supratentorial Glioblastoma: Health-Related Quality of Life Results No differences in overall survival time and quality of life in elderly and/or frail patients with newly diagnosed glioblastoma multiforme.
In 2015, the International Atomic Energy Agency published results from a randomized phase 3 trial of RT in elderly or frail patients randomized to two regimens of hypofractionated RT: 40 Gy in 15 fractions over 3 weeks vs 25 Gy in 5 fractions over 1 week . A total dose of 20 Gy was prescribed to the Flair (fluid-attenuated inversion recovery) planning tumor volume (PTV) and 25 Gy to the PTV-boost (T1 MRI contrast enhanced area) in 5 daily fractions to the isodose of 67% (maximum dose within the PTV-boost was 37.5 Gy). Gy in 3 Gy fractions, 79% responded to 30 Gy in 3 Gy or 35 Gy in 3.5 Gy fractions. There was no grade ≥3 toxicity, and no patient required a re-resection due to toxicity(20). Shepherd et al. reported hypofractionated stereotactic radiotherapy in treatment of Treatment consisted of a total dose of 25 Gy in ﬁve daily fractions (dose/fraction 5.00 Gy) over 1 week in arm 1 and 40.05 Gy in 15 daily fractions (dose/fraction 2.67 Gy) over 3 weeks in arm 2. Veriﬁcation of all treatment ﬁelds on the ﬁrst day of treatment was mandatory and was then 50 Gy to PTV1 10 Gy to PTV2: 25 fractions to PTV1 5 fractions to PTV2: Central/infield 80.9% Marginal 5.7% Distant 13.3%: Median survival 14.2 mo Median time to recurrence 7.5 mo 1-y OS 66% 1-y PFS 30%: Chang Glioblastoma is a fatal illness progressive disease was defined as a new lesion or an increase by 25% or more 70 to 85) to either postoperative radiotherapy (50.4 Gy in 28 fractions) randomised patients between 60 Gy in 30 fractions versus 45 Gy in 20 fractions found that the survival HR was 1.0 (95% CI, 0.54–1.89)16, suggesting that a shorter course of radiation may be appropriate for this cohort of patients. More recently, the NOA-08 study17 randomised 412 patients to standard radiation alone of 60 Gy in 30 fractions Search Results Short Course Chemo-Radiation Therapy for Patients With Newly Diagnosed Glioblastoma Study Purpose This is a prospective, randomized, open-label, exploratory trial of temozolomide-based chemo-radiotherapy which compares two widely used established radiation schedules with either 40 Gy in 15 fractions or 25 Gy in 5 fractions with concurrent temozolomide for both schedules in Scoccianti et al.
Shepherd et al. reported hypofractionated stereotactic radiotherapy in treatment of ing tumor with a 1.5 cm margin. An isotropic expansion of 3 mm was added to the CTV 50 and CTV 60 to generate the planning target volume (PTV) 50 and PTV 60 respectively.
DNA repair pathways and the effect of radiotherapy in - DiVA
50.4–54 Gy in 28–30 fractions over 5.5–6 weeks (Grade C) 50–55 Gy in 30–33 fractions over 6–6.5 weeks (Grade C) Grade 2: 54–60 Gy in 30 fractions over 6 weeks (Grade D) Grade 3: 60 Gy in 30 fractions over 6 weeks (Grade D) The types of evidence and the grading of recommendations used within this review are based on Better survival has been reported in elderly patients treated with RT compared with those receiving supportive care alone, with similar survival outcome for patients undergoing standard RT (60 Gy over 6 weeks) and hypofractionated RT (25⁻40 Gy in 5⁻15 daily fractions). These results were confirmed by Chang et al.
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No differences in OS, PFS, or quality of life were observed between the two arms. Roa et al. reported no significant survival differences between 40 Gy in 15 fractions and 25 Gy in 5 fractions in the elderly or frail patients with GBM, suggesting that the α/β ratio of GBM could be lower than 2–3 Gy . The low α/β ratio of GBM supports the advantage of the hypofractionated approach and further studies are needed to develop the optimal dose-fractionation schedule, which meets efficacy and safety. Gy in 3 Gy fractions, 79% responded to 30 Gy in 3 Gy or 35 Gy in 3.5 Gy fractions. There was no grade ≥3 toxicity, and no patient required a re-resection due to toxicity(20).
First is the presumed equiv- rate implants (16, 22–27). 2017-12-01
Recently, in a phase I dose-escalation study, Chen and co-workers demonstrated that 60 Gy can be delivered with IMRT in 6-Gy fractions within 2 weeks (BED for glioblastoma multiforme, 119.4 Gy; equivalent dose in 2 Gy per fraction-EQD2-for normal brain, 108.9 Gy) with concurrent and adjuvant TMZ without unacceptable acute toxicity .In our previous study it has been shown that accelerated
Reirradiation of glioblastoma through the use of a Reduced dose Rate on a tomotherapy unit www.tcrt.org Pulsed Reduced Dose Rate (standard 2 Gy fraction, 2 Gy in ten 0.2 Gy fractions without gridblocking, two grid HR = 1.82 with a 95% CI ranging from 1.25 to 3.10). These data compare favor-
A short-course RT regimen of 25 Gy in 5 fractions is an acceptable treatment option for patients aged ≥65 years, mainly those with a poor performance status or contraindication to chemotherapy, which would be indicated in cases of methylated O6 methylguanine-DNA-methyltransferase promoter tumors. Active Comparator: 25 Gy in 5 fractions Patients randomized to 25 Gy in 5 fractions will receive 150 mg/m^2 temozolomide per day for 5 days starting the first day of radiotherapy. This treatment will be followed by standard monthly 5 day cycles at 150 mg/m^2 for upto 1 year. 2017-07-15 · Following this tendency, the IAEA proposed a randomized trial comparing 25 Gy in 5 fractions over a period of 1 week versus 40 Gy in 15 fractions over a period of 3 weeks . The trial was designed to evaluate noninferior survival outcomes between the 2 arms.
The MS was 5.1 months in the SRT group and 5.6 months in the HRT group (p = 0.57) that established the non-inferiority of HRT compared to SRT in older patients with GBM. 17 The same group in a subsequent Phase III trial randomised 98 patients (frail = KPS 50 to 70 OR elderly = ≥65 years OR both) to two different HRT schedules of Arm 1 = 25 Gy/5F (1 week) or Arm 2 = 40 Gy/15 F (3 weeks). with glioblastoma. Based on evidence from the CE.6 randomized controlled trial, hypofractionated radiation therapy administered over a three-week course (40 Gy in 15 fractions) concomitantly with temozolomide (TMZ) followed by adjuvant TMZ has been found to be superior to radiation therapy alone with mean OS Currently, many approaches are available for the salvage treatment of patients with recurrent GBM, including resection, re-irradiation or systemic agents, but no standard of care exists.Methods: We analysed a cohort of patients with recurrent GBM treated with frame-less hypofractionated stereotactic radiation therapy with a total dose of 25 Gy in 5 fractions.Results: Of 91 consecutive patients fractions of 1.8 Gy per fraction or 60 Gy in 30 fractions of 2 Gy per fraction. Concurrent TMZ dosage was 75 mg/m2 given daily, 7 days per week, during radiation, whereas adjuvant TMZ was initiated at 150 mg/m2 on days 1 to 5 of 28-day cycles 1 month after radiation and escalated to 200 mg/m2, if toxicity was acceptable, for 5 to 11 addi- techniques (standard 2 Gy fraction, 2 Gy in ten 0.2 Gy fractions without gridblocking, two grid patterns, and a combination plan incorporating bothgrids) and analyzed with conformation numbers (CN), homogeneity indexes (HI),and dose volumes to normal tissues.
Gy. Eller (oavsett MGMT) enbart Data för barn med diffuse intrinsic midline glioma (DIPG) talar för att dessa tumörer comparing 35Gy in ten fractions with 60Gy in 30 fractions of cerebral irradiation for. GBM”.
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Klinisk prövning på Glioblastoma: Dendritic Cell/Tumor Fusion
A short-course RT regimen of 25 Gy in 5 fractions is an acceptable treatment option for patients aged ≥65 years, mainly those with a poor performance status or contraindication to chemotherapy, which would be indicated in cases of methylated O6 methylguanine-DNA-methyltransferase promoter tumors. 2017-07-15 Better survival has been reported in elderly patients treated with RT compared with those receiving supportive care alone, with similar survival outcome for patients undergoing standard RT (60 Gy over 6 weeks) and hypofractionated RT (25⁻40 Gy in 5⁻15 daily fractions). 2020-11-09 2019-06-06 2019-11-12 The treatment was delivered in 25 fractions with the dose to PTV1 escalated in three dose levels (60 Gy, 62.5 Gy, 65 Gy) while maintaining the dose for PTV2 constant at 45 Gy. The study reported no DLT and the pattern of recurrence was predominantly central, with only two patients relapsing outside the PTV1 and one patient developing marginal recurrence. More recently, shorter regimens such as 25 Gy/5 fractions and 34 Gy/10 fractions have shown to be equally effective in elderly and/or frail patients.