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High-Dose Conformal Radiotherapy Influenced the Pattern of Failure But Did Not Improve Survival in Glioblastoma Multiforme |
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| Authors: | Keiichi Nakagawa M.D. Yukimasa Aoki M.D. Takamitsu Fujimaki M.D. Masao Tago M.D. Atsuro Terahara M.D. Katsuyuki Karasawa M.D. Kouichi Sakata M.D. Yasuhito Sasaki M.D. Masao Matsutani M.D. Atsuo Akanuma M.D. |
| Affiliation: | A Department of Radiology, University of Tokyo, 7-3-1 Hongo Tokyo, 113 Japan B Department of Neurosurgery, University of Tokyo, 7-3-1 Hongo Tokyo, 113 Japan; C Division of Radiation Medicine, National Institute for Radiological Sciences, 4-9-1 Anagawa Chiba-city, 260 Japan D Division of Radiation Health, National Institute for Radiological Sciences, 4-9-1 Anagawa Chiba-city, 260 Japan; E Department of Radiology, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Tokyo, 113 Japan; F Department of Radiology, Sapporo Medical School, S1W16, Chuo-Ku, Sapporo, 060 Japan; G Department of Neurosurgery, Saitama Medical School, 38 Morohongo, Moroyamacho, 350-04 Japan |
| Abstract: | Background and Purpose: Although glioblastoma multiforme is clearly radiation-resistant, there is evidence of a dose–dependent response relationship. The purpose of the study was to evaluate the impact of higher dose by rotational multileaf collimator (MLC) conformal radiation therapy. Materials and Methods: From 1984 to 1995, 38 consecutive cases with intracranial glioblastoma multiforme were treated using the rotational MLC conformal therapy. There were 25 men and 13 women with a median age of 47 years (12–73 years, mean 46.5 years). Median Karnofsky performance score was 80 (30–100, mean 78.2). Median tumor volume was 64 cc (8–800 cc, mean 110.3 cc). All underwent surgical intervention (only biopsy in 1, partial resection in 13, subtotal resection in 21, and gross total resection in 3). Radiation dose to was 60 to 80 Gy (median 68.5 Gy, mean 68.3 Gy) in 21 patients treated before 1990 and 90 Gy in the 17 patients thereafter. Biweekly i.v. chemotherapy was also administered for both arms. Results: The 1-year, 2-year, 5-year, and 10-year overall survival rates were 75%, 42%, 20%, and 15%, respectively. Univariate analysis showed the initial tumor volume, residual tumor volume, and Karnofsky performance score were statistically significant factors for survival. Only the residual tumor volume was statistically significant by multivariate analysis. The 5-year survival rate of patients with residual tumors of 5 cc or less in volume was as good as 37%. Survival of the 90-Gy Group appeared inferior to that of the Low-Dose Group, though no statistical difference was seen (the 3-year survival was 40% vs. 22%). Local failure was observed in 16 of the 19 recurrences in the Low-Dose Group, whereas it was observed in only 4 of the 13 recurrences in the 90-Gy Group. The difference in pattern of failure was statistically significant. Two patients of the High-Dose Group developed radiation necrosis and one died of it. Conclusions: The high-dose conformal radiotherapy did not improve survival in the disease, but did change the pattern of failure. |
| Keywords: | Glioblastoma multiforme Radiotherapy Conformal therapy Pattern of failure |
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