and Accelerated Radiotherapy for Patients with Glioblastoma
Shenouda, L. Souhami, E.B. Podgorsak, J.P. Bahary, J.G. Villemure,
J.L. Caron and G. Mohr
Objective: To assess the feasibility, toxicity,
and local control of stereotactic radiosurgery followed by
accelerated external beam radiotherapy (AEBR) for patients
with glioblastoma multiforme. Materials and methods:
Six males and eight females, with a median age of
67.5 years (range 45-78 years), entered the study. Karnofsky
performance status was 90 for five, 80 for six, and 60 for
three patients. Following surgery, the patients were left
with a residual mass ² 4 cm. Radiosurgery was delivered with
a single dose of 20 Gy to the 90% isodose surface corresponding
to the contrast-enhancing edge of the tumour. A total AEBR
dose of 60 Gy in 30 fractions was delivered using a concomitant
boost technique over four weeks. Results: Median
survival time was 40 weeks (range 17-80 weeks). Actuarial
survivals at 12 and 18 months were 43% and 14%, respectively.
The median time to progression was 25 weeks (range 2-77 weeks).
One patient developed a seizure on the day of stereotactic
radiosurgery. Two patients experienced somnolence at 47 and
67 days post-radiotherapy. Eight patients remained steroid-dependent.
Radiological evidence of leukoencephalopathy was observed
in one patient, and brain necrosis in two additional patients
at 30 and 63 weeks. One of these two patients with brain necrosis
developed complete loss of vision in one eye, and decreased
vision in the contralateral eye at 63 weeks. Conclusion:
Stereotactic radiosurgery followed by AEBR was feasible but
was associated with late complications. The use of such radiosurgical
boost for patients with glioblastoma multiforme should be
reserved for those patients entering controlled clinical trials.
J. Neurol. Sci. 1997; 24: 110-115