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

Anahtar Kelimeler:

Glioblastoma Multiforme, Tomoterapi, Radyoterapi

The Helical Tomotherapy Experience on Radiotherapy of The Helical Tomotherapy Experience on Radiotherapy of Glioblastoma Multiforme Glioblastoma Multiforme Glioblastoma Multiforme Radyoterapisinde Helikal Tomoterapi Deneyimi

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

Keywords:

Glioblastoma Multiforme, Tomotherapy, Radiotherapy,

PDF

___

Laperriere N, Zuraw L, Cairncross G; Cancer Care Ontario Practice Guidelines Initiative Neuro-Oncology Disease Site Group. Radiotherapy for newly diagnosed malignant glioma in adults a systematic review. Radiat and Oncol 2002; 64: 259-73.
Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO; European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastome. N Eng J Med 2005; 352: 987-96.
Hegi ME, Diserens A, Gorlia T, Hamou MF, de Tribolet N, Weller M, Kros JM, Hainfellner JA, Mason W, Mariani L, Bromberg JE, Hau P, Mirimanoff RO, Cairncross JG, Janzer RC, Stupp R. MGMT gene silencing and benefi t from temozolomide in glioblastome. N Eng J Med 2005; 352: 997-1003.
Garden AS, Maor MH,Yung WK, Bruner JM,Woo SY,Moser RP, Lee YY. Outcome and patterns of failure following limited-volume irradiation for malignant astrocytomas. Radother Oncol 1991; 20: 99-110.
Wallner KE, Galicich JH, Krol G, Arbit E, Malkin MG. Patterns of failure following treatment for glioblastome multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 1989; 16: 1405-9.
Fuller CD, Choi M, Forthuber B, Wang SJ,Rajagiriyil N, Salter BJ, Fuss M. Standart fractionation intensity modulated radiation therapy (IMRT) of primary and recurrent glioblastome multiforme. Radiat Oncol 2007; 2007;14;2:26.
MacDonald SM, Ahmad S, Kachris S, Vogds BJ, DeRouen M, Gittleman AE, DeWyngaert K, Vlachaki MT. Intensity modulated radiation therapy versus three-dimensional conformal radiation therapy for the treatment of high grade glioma: A dosimetric comparison. J Appl Clin Med Phys 2007; 8: 47-60.
Aherne NJ, Benjamin LC, Horsley PJ, Silva T, Wilcox S, Amalaseelan J, Dwyer P, Tahir AM, Hill J, Last A, Hansen C, McLachlan CS, Lee YL, McKay MJ, Shakespeare TP. Improved outcomes with intensity modulated radiation therapy combined with temozolomide for newly diagnosed glioblastome multiforme. Neu Res Int 2014: 1-5.
Welsh JS, Patel RR, Ritter MA, Harari PM, Mackie TR, Mehta MP. Helical tomotherapy: An innovative technology and approach to radiation therapy. Technol Cancer Res Treat 2002; 1(4): 311-6.
Burnet NG, Adams EJ, Fairfoul J, Tudor GS, Hoole AC, Routsis DS, Dean JC, Kirby RD, Cowen M, Russell SG, Rimmer YL, Thomas SJ. Practical aspects of implementation of helical tomotherapy for intensity- modulated and image-guided radiotherapy. Clin Oncol 2010; 22(4): 294-312.
Van herk M. Different styles of image-guided radiotherapy. Semin Radiat Oncol 2007; 17(4): 258-67.
Hermanto U, Frija EK, Lii MJ, Chang EL, Mahajan A, Woo SY. Intensity-modulated radiotherapy (IMRT) and conventional three-dimensional conformal radiotherapy for high grade gliomas: does IMRT increase the integral dose to normal brain? Int J Radiat Oncol Biol Phys 2007; 67(4): 1135-44.
Minniti G, Amelio D, Amichetti M, Salvati M, Muni R, Bozzao A, Lanzetta G, Scarpino S, Arcella A, Enrici RM. Patterns of failure and comparison of different target volume delineations in patients with glioblastome treated with conformal radiotherapy plus concomitant and adjuvant temozolomide. Radiother Oncol 2010; 97: 377- 81.
Reddy K, Damek D, Gaspar LE, Ney D, Waziri A, Lillehei K, Stuhr K, Kavanagh BD, Chen C. Phase II trial of hypofractionated IMRT with temozolomide for patients with newly diagnosed glioblastoma multiforme. Int J Radiat Oncol Biol Phys 2012; 84(3): 655-60.
Tsien CI, Brown D, Normolle D, Schipper M, Piert M, Junck L, Heth J, Gomez-Hassan D, Ten Haken RK, Chenevert T, Cao Y, Lawrence T. Concurrent temozolomide and dose-escalated intensity-modulated radiation therapy in newly diagnosed glioblastoma. Clin Cancer Res 2012; 18(1): 273-9.
Floyd NS, Woo SY, Teh BS, Prado C, Mai WY, Trask T, Gildenberg PL, Holoye P, Augspurger ME, Carpenter LS, Lu HH, Chiu JK, Grant WH 3rd, Butler EB. Hypofractionated intensity-modulated radiotherapy for primary glioblastoma multiforme. Int J Radiat Oncol Biol Phys 2004; 58(3): 721-26.
Gutin PH, Prados MD, Phillips TL Wara WM, Larson DA, Leibel SA, Sneed PK, Levin VA, Weaver KA, Silver P, et al. External irradiation followed by an interstitial high activity iodine 0125 implant “boost” in the initial treatment of malignant gliomas: NCOG study 6G-82-2. Int J Radiat Oncol Biol Phys 1991; 21: 601-6.
Mackie TR, Balog J, Ruchala K, Shepard D, Aldridge S, Fitchard E, Reckwerdt P, Olivera G, McNutt T, Mehta M. Tomotherapy. Semin Radiat Oncol 1999; 9(1): 108- 17.
Ken S, Vieillevigne L, Franceries X, Simon L, Supper C, Lotterie JA, Filleron T, Lubrano V, Berry I, Cassol E, Delannes M, Celsis P, Cohen-Jonathan EM, Laprie A. Integration method of 3D MR spectroscopy into treatment planning system for glioblastoma IMRT dose painting with integrated simultaneous boost. Radiat Oncol 2013; 8: 1.
Ang KK, Jiang JL, Guttenberger R, Thames HD, Stephens LC, Smith CD, Feng Y. Impact of spinal cord repair kinetics on the practice of altered fractionation schedules. Radiother Oncol 1992; 25: 287-94.
Mayer R, Sminia P. Reirradiation tolerance of the human brain. Int J Radiat Oncol Biol Phys 2008; 70: 1350-60.
Chang EL, Akyurek S, Avalos T, Rebueno N, Spicer C, Garcia J, Famiglietti R, Allen PK, Chao KS, Mahajan A, Woo SY, Maor MH. Evaluation of peritumoral edema in the delineation of radiotherapy clinical target volumes for glioblastome. Int J Radiat Oncol Biol Phys 2007; 68: 144- 50.
Murai T, Shibamoto Y, Manabe Y, Murata R, Sugie C, Hayashi A, Ito H, Miyoshi Y. Intensity-modulated radiation therapy using static ports of tomotherapy (TomoDirect): Comparison with the TomoHelical mode. Radiat Oncol 2013; 8: 68.
Jager PL, Vaalburg W, Pruim J, de Vries EG, Langen KJ, Piers DA. Radiolabeled amino acids: basic aspects and clinical applications in oncology. J Nuc Med 2001; 42: 432-45.