• Int. J. Radiat. Oncol. Biol. Phys. · Mar 2006

    Intensity-modulated radiotherapy in high-grade gliomas: clinical and dosimetric results.

    • Ashwatha Narayana, Josh Yamada, Sean Berry, Priti Shah, Margie Hunt, Philip H Gutin, and Steven A Leibel.
    • Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. narayana@mskcc.org
    • Int. J. Radiat. Oncol. Biol. Phys. 2006 Mar 1; 64 (3): 892-7.

    PurposeTo report preliminary clinical and dosimetric data from intensity-modulated radiotherapy (IMRT) for malignant gliomas.Methods And MaterialsFifty-eight consecutive high-grade gliomas were treated between January 2001 and December 2003 with dynamic multileaf collimator IMRT, planned with the inverse approach. A dose of 59.4-60 Gy at 1.8-2.0 Gy per fraction was delivered. A total of three to five noncoplanar beams were used to cover at least 95% of the target volume with the prescription isodose line. Glioblastoma accounted for 70% of the cases, and anaplastic oligodendroglioma histology (pure or mixed) was seen in 15% of the cases. Surgery consisted of biopsy only in 26% of the patients, and 80% received adjuvant chemotherapy.ResultsWith a median follow-up of 24 months, 85% of the patients have relapsed. The median progression-free survival time for anaplastic astrocytoma and glioblastoma histology was 5.6 and 2.5 months, respectively. The overall survival time for anaplastic glioma and glioblastoma was 36 and 9 months, respectively. Ninety-six percent of the recurrences were local. No Grade IV/V late neurologic toxicities were noted. A comparative dosimetric analysis revealed that regardless of tumor location, IMRT did not significantly improve target coverage compared with three-dimensional planning. However, IMRT resulted in a decreased maximum dose to the spinal cord, optic nerves, and eye by 16%, 7%, and 15%, respectively, owing to its improved dose conformality. The mean brainstem dose also decreased by 7%. Intensity-modulated radiotherapy delivered with a limited number of beams did not result in an increased dose to the normal brain.ConclusionsIt is unlikely that IMRT will improve local control in high-grade gliomas without further dose escalation compared with conventional radiotherapy. However, it might result in decreased late toxicities associated with radiotherapy.

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