Accelerated fractionated proton/photon irradiation to 90 cobalt gray equivalent for glioblastoma multiforme: results of a phase II prospective trial

作者：Markus M. Fitzek, Allan F. Thornton, James David Rabinov, Michael H. Lev, Francisco S. Pardo, John E. Munzenrider, Paul G Okunieff, Marc R. Bussière, Ilana Monica Braun, Fred H. Hochberg, E. Tessa Hedley‐Whyte, Norbert J. Liebsch, Griffith Rutherford Harsh · 发表于：Journal of neurosurgery · 年份：1999 · DOI：10.3171/jns.1999.91.2.0251 · 被引用次数：258 · 研究领域：Glioma Diagnosis and Treatment、Radiation Therapy and Dosimetry、Advanced Radiotherapy Techniques

OBJECT: After conventional doses of 55 to 65 Gy of fractionated irradiation, glioblastoma multiforme (GBM) usually recurs at its original location. This institutional phase II study was designed to assess whether dose escalation to 90 cobalt gray equivalent (CGE) with conformal protons and photons in accelerated fractionation would improve local tumor control and patient survival. METHODS: Twenty-three patients were enrolled in this study. Eligibility criteria included age between 18 and 70 years, Karnofsky Performance Scale score of greater than or equal to 70, residual tumor volume of less than 60 ml, and a supratentorial, unilateral tumor. Actuarial survival rates at 2 and 3 years were 34% and 18%, respectively. The median survival time was 20 months, with four patients alive 22 to 60 months postdiagnosis. Analysis by Radiation Therapy Oncology Group prognostic criteria or Medical Research Council indices showed a 5- to 11-month increase in median survival time over those of comparable conventionally treated patients. All patients developed new areas of gadolinium enhancement during the follow-up period. Histological examination of tissues obtained at biopsy, resection, or autopsy was conducted in 15 of 23 patients. Radiation necrosis only was demonstrated in seven patients, and their survival was significantly longer than that of patients with recurrent tumor (p = 0.01). Tumor regrowth occurred most commonly in areas that received doses of 60 to 70 CGE or less; recurrent ...