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Glioblastoma Multiforme Glioblastoma Multiforme Radyoterapisinde Helikal Tomoterapi Deneyimi

Amaç: Glioblastome Multiforme'de (GBM) standart tedavi cerrahi rezeksiyon sonrası eşzamanlı kemoradyoterapi ve adjuvant temozolamiddir. Intensity Modulated Radiotherapy (IMRT) normal dokuları koruyarak tümöre daha yüksek dozlar verebilme ve Simultaneous Integrated Boost (SIB) imkanı sunar. Gereç ve Yöntemler: 12 beyin tümörlü hastanın yedisi glioblastome multiforme, üçü anaplastik oligoastrositom, ikisi radyolojik olarak yüksek gradlı glial tümördü. Hastalara toplam 60 Gy SIB-IMRT yapıldı. Tüm hastalara eşzamanlı temozolomid verildi.Bulgular: Tedavi sonrası Manyetik Rezonans Görüntüleme (MRG) sonuçları tam rezeksiyon yapılan 8 hastada rekürrens olmadığını, 2 hastada parsiyel yanıt, 2 hastada da hiç yanıt alınmadığını gösterdi. Grad 3 hematolojik toksisite 1 hastada görüldü. 12 aylık ortanca takip süresi sonunda üç hasta hastalıksız yaşarken 9 hasta eksitus oldu. Toplam yaşam süresi 14,8 ay ve ortanca progresyonsuz sağkalım 4,4 ay idi. Beyin sapının aldığı ortalama doz 12,90 Gy iken optik kiazma için 12,72 Gy'dir. Sonuç: Optik kiazma ve beyin sapı gibi kritik organlara verilen dozlar düşürülürken, hedef volüme verilen doz SIB-IMRT ile arttırılmıştır.

The Helical Tomotherapy Experience on Radiotherapy of The Helical Tomotherapy Experience on Radiotherapy of Glioblastoma Multiforme

Objective: The standard treatment of Glioblastome Multiforme (GBM) is surgical resection followed by chemoradiotherapy and adjuvant temozolamide. Intensity Modulated Radiotherapy (IMRT) offer an advantage in terms of reducing the dose to critical normal structures and a reduced dose to the normal brain. It also offers application of Simultaneous Integrated Boost (SIB).Material and Methods: Among our 12 patients, 7 had a diagnosis of GBM whereas 3 of them were anaplastic oligoastrocytoma and 2 of them were diagnosed radiologically as high-grade glial tumor. In all patients, 60 Gy SIB-IMRT with concomitant Temozolomide was used. Results: In post treatment Magnetic Resonance Imaging (MRI), 8 patients had no recurrence whereas 2 patients showed partial response and in 2 patients there was no response at all. After a median follow-up period of 12 months, 3 patients survived disease free, and 9 patients were expired. The overall survival was 14.8 months. Median progression free survival was 4.4 months. The mean dose received by the brain stem was 12.90 Gy and 12.72 Gy for the optic chiasm.Conclusion: High doses can be given while protecting critical tissues with SIB-IMRT.

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