Prognostic factors in glioblastoma multiforme patients receiving high-dose particle radiotherapy or conventional radiotherapy

AbstractThe goals of this study were (1) to compare, in a single institute, the clinical results of patients with newly diagnosed glioblastoma multiforme (GBM) treated with stereotactic radiosurgery (SRS), which has been incorporated into the initial management approach, with thosein-patientstreated with intra-operative radiotherapy (IORT) and (2) to assess whether these local irradiation boost therapies are prognostic factors on survival analysis. One hundred and twenty adult patients with supratentorial GBM had undergone tumour resection or biopsy and had received external beam radiotherapy (EBRT). Of them, 31 underwent IORT, 29 underwent SRS, and the remaining 60 had no local high-dose irradiation boost. The local irradiation boost led to clearly better results on survival of GBM patients. Furthermore, SRS is less invasive and allows for meticulous target planning of the irradiation boost, and was superior to IORT in terms of survival prolongation as well as suppression of local tumour recurrence/progression at the primary site in this series. In addition, SRS was a significant, positive prognostic factor for survival as well as gross-total resection of the tumour, and could be an alternative therapeutic modality to IORT for GBM.

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Dual-isotope single-photon emission computerized tomography scanning in patients with glioblastoma multiforme: association with patient survival and histopathological characteristics of tumor after high-dose radiotherapy

Journal of Neurosurgery ◽

10.3171/jns.1998.89.1.0060 ◽

1998 ◽

Vol 89 (1) ◽

pp. 60-68 ◽

Cited By ~ 29

Author(s):

Richard B. Schwartz ◽

B. Leonard Holman ◽

Joseph F. Polak ◽

Basem M. Garada ◽

Marc S. Schwartz ◽

...

Keyword(s):

Survival Rate ◽

Glioblastoma Multiforme ◽

Single Photon ◽

Photon Emission ◽

High Dose ◽

Term Survival ◽

Content Type ◽

Dual Isotope ◽

Fine Print

Object. The study was conducted to determine the association between dual-isotope single-photon emission computerized tomography (SPECT) scanning and histopathological findings of tumor recurrence and survival in patients treated with high-dose radiotherapy for glioblastoma multiforme. Methods. Studies in which SPECT with 201Tl and 99mTc-hexamethypropyleneamine oxime (HMPAO) were used were performed 1 day before reoperation in 47 patients with glioblastoma multiforme who had previously been treated by surgery and high-dose radiotherapy. Maximum uptake of 201Tl in the lesion was expressed as a ratio to that in the contralateral scalp, and uptake of 99mTc-HMPAO was expressed as a ratio to that in the cerebellar cortex. Patients were stratified into groups based on the maximum radioisotope uptake values in their tumor beds. The significance of differences in patient gender, histological characteristics of tissue at reoperation, and SPECT uptake group with respect to 1-year survival was elucidated by using the chi-square statistic. Comparisons of patient ages and time to tumor recurrence as functions of 1-year survival were made using the t-test. Survival data at 1 year were presented according to the Kaplan—Meier method, and the significance of potential differences was evaluated using the log-rank method. The effects of different variables (tumor type, time to recurrence, and SPECT grouping) on long-term survival were evaluated using Cox proportional models that controlled for age and gender. All patients in Group I (201Tl ratio < 2 and 99mTc-HMPAO ratio < 0.5) showed radiation changes in their biopsy specimens: they had an 83.3% 1-year survival rate. Group II patients (201T1 ratio < 2 and 99mTc-HMPAO ratio of ≥ 0.5 or 201Tl ratio between 2 and 3.5 regardless of 99mTc-HMPAO ratio) had predominantly infiltrating tumor (66.6%); they had a 29.2% 1-year survival rate. Almost all of the patients in Group III (201Tl ratio > 3.5 and 99mTc-HMPAO ratio ≥ 0.5) had solid tumor (88.2%) and they had a 6.7% 1-year survival rate. Histological data were associated with 1-year survival (p < 0.01); however, SPECT grouping was more closely associated with 1-year survival (p < 0.001) and was the only variable significantly associated with long-term survival (p < 0.005). Conclusions. Dual-isotope SPECT data correlate with histopathological findings made at reoperation and with survival in patients with malignant gliomas after surgical and high-dose radiation therapy.

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Glioblastoma: Prognostic Factors and Predictive Response to Radio and Chemotherapy

Current Medicinal Chemistry ◽

10.2174/0929867327666200131095256 ◽

2020 ◽

Vol 27 (17) ◽

pp. 2814-2825

Author(s):

Francesco Fiorica ◽

Maria Colella ◽

Rosaria Taibi ◽

Andrea Bonetti ◽

Jacopo Giuliani ◽

...

Keyword(s):

Prognostic Factors ◽

Glioblastoma Multiforme ◽

Poor Prognosis ◽

Therapeutic Strategy ◽

Biological Factors ◽

Near Future ◽

Predictive Response

: Glioblastoma multiforme (GBM) is characterized by poor prognosis despite an aggressive therapeutic strategy. In recent years, many advances have been achieved in the field of glioblastoma biology. : Here we try to summarize the main clinical and biological factors impacting clinical prognostication and therapy of GBM patients. From that standpoint, hopefully, in the near future, personalized therapies will be available.

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CONVENTIONAL VERSUS THREE-DIMENSIONAL CONFORMAL EXTERNAL RADIOTHERAPY IN CANCER CERVIX: A COMPARATIVE STUDY FOR COMPLIANCE, RESPONSE AND TOXICITY

SRMS Journal of Medical Science ◽

10.21761/jms.v1i2.7127 ◽

2016 ◽

Vol 1 (2) ◽

Author(s):

Richa Gupta ◽

Piyush Kumar ◽

D. P. Singh ◽

Arvind Kumar Chauhan ◽

Kamal Sahni

Keyword(s):

Clinical Response ◽

Three Dimensional ◽

Common Side Effect ◽

P Value ◽

High Dose ◽

Cancer Cervix ◽

Conventional Radiotherapy ◽

Radiation Fields ◽

Group A ◽

Group B

INTRODUCTION: Cervical cancer is the second most frequent cancer among Indian women. Radiotherapy is the cornerstone of treatment in all its stages. Three-dimensional conformal radiotherapy (3DCRT) combines multiple radiation fields to deliver precise dose of radiation to the affected area. Tailoring each of the radiation fields to focus on the tumor delivers a high dose of radiation to the tumor and avoids nearby healthy tissue. The present study is done to compare conventional radiotherapy versus 3DCRT in cancer cervix for compliance, clinical response and toxicity. MATERIAL AND METHODS: Fifty patients were enrolled and randomised into two radiotherapy plans with radical intent - Group A treated by conventional radiotherapy and group B treated by 3DCRT. Concurrent cisplatin was delivered on weekly (35mg/m2) or tri-weekly (75mg/m2) basis during external beam Radiotherapy and was followed by High Dose Radiotherapy Brachytherapy. Clinical response and complication assessment were evaluated.Collected data was analyzed using standard statistical methods and softwares to calculate level of significance using “p” value by chi square test. RESULTS: In this study mean age of the patients was 48 years (26-67 years). The anemia was the most common side effect seen in both groups (96% vs 88%, p=0.29). Neutropenia was more in group B (36% vs 44%, p= 0.56). Lower GI toxicity was seen only in patients in group A (20% vs 0%, p=0.018). In follow up there were no significant early rectal and bladder reactions in both groups and 2 patients in each group had late rectal reactions of grade I and II (p= 0.312). No significant skin, bladder and small intestinal toxicity were seen in both groups. CONCLUSION: Conventional radiotherapy gives equally efficacious response though accompanied by toxicities which were acceptable.

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Patients with Primary Central Nervous System Lymphoma Not Eligible for Clinical Trials: Prognostic Factors, Treatment and Outcome

Cancers ◽

10.3390/cancers13122934 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2934

Author(s):

Sabine Seidel ◽

Michelle Margold ◽

Thomas Kowalski ◽

Alexander Baraniskin ◽

Roland Schroers ◽

...

Keyword(s):

Central Nervous System ◽

Clinical Trials ◽

Nervous System ◽

Prognostic Factors ◽

Central Nervous System Lymphoma ◽

Initial Response ◽

Early Response ◽

Multicenter Trial ◽

High Dose ◽

Therapeutic Trials

Patients with primary central nervous system lymphoma (PCNSL) not fulfilling inclusion criteria for clinical trials represent an underreported population. Thirty-four consecutive PCNSL patients seen at our center between 2005 and 2019 with exclusion criteria for therapeutic trials were analyzed (non-study patients) and compared with patients from the G-PCNSL-SG-1 (German PCNSL Study Group 1) study (study patients), the largest prospective multicenter trial on PCNSL, comprising 551 patients. Median follow up was 68 months (range 1–141) in non-study patients and 51 months (1–105) in study patients. Twenty-seven/34 (79.4%) non-study patients received high dose methotrexate (HDMTX), while seven/34 (20.6%) with a glomerular filtration rate (GFR) < 50 mL/min did not. Median overall survival (OS) was six months (95% confidence interval [CI] 0–21 months) in those 34 non-study patients. The 27 non-study patients treated with HDMTX were compared with 526/551 G-PCNSL-SG-1 study patients who had received HDMTX as well. Median OS was 20 months (95% CI 0–45)/21 months (95% CI 18–25) in 27 non-study/526 study patients (p = 0.766). Favorable prognostic factors in non-study patients were young age, application of HDMTX and early response on magnet resonance imaging (MRI). If HDMTX-based chemotherapy can be applied, long-term disease control is possible even in patients not qualifying for clinical trials. Initial response on early MRI might be useful for decision on treatment continuation.

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Anthropometric and Pharmacotherapeutic Variables on Acute Emesis Induced by Cisplatin-Containing Chemotherapy

Annals of Pharmacotherapy ◽

10.1345/aph.19188 ◽

2000 ◽

Vol 34 (5) ◽

pp. 573-579 ◽

Cited By ~ 2

Author(s):

José Luis Catalán Arlandis ◽

N Víctor Jiménez Torres

Keyword(s):

Prognostic Factors ◽

Odds Ratio ◽

Logistic Model ◽

Therapeutic Failure ◽

High Dose ◽

Anthropometric Parameters ◽

Cycle Number ◽

Chemotherapeutic Regimen ◽

Acute Emesis ◽

First Choice

OBJECTIVE: To characterize the effects of anthropometric and pharmacotherapeutic variables on acute emesis induced by cisplatin-containing regimens with dosages ·50 mg·m−2. METHODS: A prospective, cross-sectional, noncontrolled study was performed to analyze acute vomiting during the first 24 hours in patients treated in a Spanish hospital. The patients received an intravenous combination of drugs (2 doses of metoclopramide 3 mg/kg, dexamethasone 20 mg) as first-choice antiemetic therapy. Intravenous ondansetron 8 mg and dexamethasone 20 mg served as an alternative regimen in patients <30 years old with a history of extrapyramidal manifestations or emesis in previous cycles. Therapeutic failure was used as a dependent variable, defined as three or more vomiting episodes documented by the patients. Other variables were the chemotherapeutic regimen; antiemetic regimen; patient gender, age, weight, and height; and cycle number. The reference logistic model and two reduced-models derived from the latter were designed. The logistic models were subsequently validated by means of receiving operating characteristic curves. RESULTS: A total of 319 cycles involving 106 patients were studied. The metoclopramide regimen was administered in 66% of the cycles. The therapeutic failure rate was 21% for the metoclopramide regimen and 32% for the ondansetron treatment. The logistic model developed identified the type of chemotherapeutic regimen provided as the most significant prognostic variable (p < 0.0001). Patient weight (odds ratio 1.64) and height (odds ratio 1.28) were identified as prognostic factors related with therapeutic failure. CONCLUSIONS: The type of chemotherapeutic regimen administered and the anthropometric characteristics of the patients exert a clear conditioning effect on risks associated with therapeutic failure against acute emesis following high-dose cisplatin therapy. Such anthropometric parameters have not been previously identified as prognostic factors.

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