Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma

Abstract Background The dismal overall survival (OS) prognosis of glioblastoma, even after trimodal therapy, can be attributed mainly to the frequent incidence of intracranial relapse (ICR), which tends to present as an in-field recurrence after a radiation dose of 60 Gray (Gy). In this study, molecular marker-based prognostic indices were used to compare the outcomes of radiation with a standard dose versus a moderate dose escalation. Methods This retrospective analysis included 156 patients treated between 2009 and 2016. All patients were medically fit for postoperative chemoradiotherapy. In the dose-escalation cohort a simultaneous integrated boost of up to 66 Gy (66 Gy RT) within small high-risk volumes was applied. All other patients received daily radiation to a total dose of 60 Gy or twice daily to a total dose of 59.2 Gy (60 Gy RT). Results A total of 133 patients received standard 60 Gy RT, while 23 received 66 Gy RT. Patients in the 66 Gy RT group were younger (p < 0.001), whereas concomitant temozolomide use was more frequent in the 60 Gy RT group (p < 0.001). Other intergroup differences in known prognostic factors were not observed. Notably, the median time to ICR was significantly prolonged in the 66 Gy RT arm versus the 60 Gy RT arm (12.2 versus 7.6 months, p = 0.011), and this translated to an improved OS (18.8 versus 15.3 months, p = 0.012). A multivariate analysis revealed a strong association of 66 Gy RT with a prolonged time to ICR (hazard ratio = 0.498, p = 0.01) and OS (hazard ratio = 0.451, p = 0.01). These differences remained significant after implementing molecular marker-based prognostic scores (ICR p = 0.008, OS p = 0.007) and propensity-scored matched pairing (ICR p = 0.099, OS p = 0.023). Conclusion Radiation dose escalation was found to correlate with an improved time to ICR and OS in this cohort of glioblastoma patients. However, further prospective validation of these results is warranted. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Sebastian Zschaeck [verfasserIn] Peter Wust [verfasserIn] Reinhold Graf [verfasserIn] Martin Misch [verfasserIn] Julia Onken [verfasserIn] Pirus Ghadjar [verfasserIn] Harun Badakhshi [verfasserIn] Julian Florange [verfasserIn] Volker Budach [verfasserIn] David Kaul [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2018

Schlagwörter:	Glioblastoma Radiotherapy Temozolomide Dose escalation Simultaneous integrated boost

Übergeordnetes Werk:	In: Radiation Oncology - BMC, 2006, 13(2018), 1, Seite 9
Übergeordnetes Werk:	volume:13 ; year:2018 ; number:1 ; pages:9

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1186/s13014-018-1194-8

Katalog-ID:	DOAJ038067838

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520			\|a Abstract Background The dismal overall survival (OS) prognosis of glioblastoma, even after trimodal therapy, can be attributed mainly to the frequent incidence of intracranial relapse (ICR), which tends to present as an in-field recurrence after a radiation dose of 60 Gray (Gy). In this study, molecular marker-based prognostic indices were used to compare the outcomes of radiation with a standard dose versus a moderate dose escalation. Methods This retrospective analysis included 156 patients treated between 2009 and 2016. All patients were medically fit for postoperative chemoradiotherapy. In the dose-escalation cohort a simultaneous integrated boost of up to 66 Gy (66 Gy RT) within small high-risk volumes was applied. All other patients received daily radiation to a total dose of 60 Gy or twice daily to a total dose of 59.2 Gy (60 Gy RT). Results A total of 133 patients received standard 60 Gy RT, while 23 received 66 Gy RT. Patients in the 66 Gy RT group were younger (p < 0.001), whereas concomitant temozolomide use was more frequent in the 60 Gy RT group (p < 0.001). Other intergroup differences in known prognostic factors were not observed. Notably, the median time to ICR was significantly prolonged in the 66 Gy RT arm versus the 60 Gy RT arm (12.2 versus 7.6 months, p = 0.011), and this translated to an improved OS (18.8 versus 15.3 months, p = 0.012). A multivariate analysis revealed a strong association of 66 Gy RT with a prolonged time to ICR (hazard ratio = 0.498, p = 0.01) and OS (hazard ratio = 0.451, p = 0.01). These differences remained significant after implementing molecular marker-based prognostic scores (ICR p = 0.008, OS p = 0.007) and propensity-scored matched pairing (ICR p = 0.099, OS p = 0.023). Conclusion Radiation dose escalation was found to correlate with an improved time to ICR and OS in this cohort of glioblastoma patients. However, further prospective validation of these results is warranted.
650		4	\|a Glioblastoma
650		4	\|a Radiotherapy
650		4	\|a Temozolomide
650		4	\|a Dose escalation
650		4	\|a Simultaneous integrated boost
653		0	\|a Medical physics. Medical radiology. Nuclear medicine
653		0	\|a Neoplasms. Tumors. Oncology. Including cancer and carcinogens
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700	0		\|a David Kaul \|e verfasserin \|4 aut
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allfields	10.1186/s13014-018-1194-8 doi (DE-627)DOAJ038067838 (DE-599)DOAJd236157f350e4dd89d5ea8dfcf20f719 DE-627 ger DE-627 rakwb eng R895-920 RC254-282 Sebastian Zschaeck verfasserin aut Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background The dismal overall survival (OS) prognosis of glioblastoma, even after trimodal therapy, can be attributed mainly to the frequent incidence of intracranial relapse (ICR), which tends to present as an in-field recurrence after a radiation dose of 60 Gray (Gy). In this study, molecular marker-based prognostic indices were used to compare the outcomes of radiation with a standard dose versus a moderate dose escalation. Methods This retrospective analysis included 156 patients treated between 2009 and 2016. All patients were medically fit for postoperative chemoradiotherapy. In the dose-escalation cohort a simultaneous integrated boost of up to 66 Gy (66 Gy RT) within small high-risk volumes was applied. All other patients received daily radiation to a total dose of 60 Gy or twice daily to a total dose of 59.2 Gy (60 Gy RT). Results A total of 133 patients received standard 60 Gy RT, while 23 received 66 Gy RT. Patients in the 66 Gy RT group were younger (p < 0.001), whereas concomitant temozolomide use was more frequent in the 60 Gy RT group (p < 0.001). Other intergroup differences in known prognostic factors were not observed. Notably, the median time to ICR was significantly prolonged in the 66 Gy RT arm versus the 60 Gy RT arm (12.2 versus 7.6 months, p = 0.011), and this translated to an improved OS (18.8 versus 15.3 months, p = 0.012). A multivariate analysis revealed a strong association of 66 Gy RT with a prolonged time to ICR (hazard ratio = 0.498, p = 0.01) and OS (hazard ratio = 0.451, p = 0.01). These differences remained significant after implementing molecular marker-based prognostic scores (ICR p = 0.008, OS p = 0.007) and propensity-scored matched pairing (ICR p = 0.099, OS p = 0.023). Conclusion Radiation dose escalation was found to correlate with an improved time to ICR and OS in this cohort of glioblastoma patients. However, further prospective validation of these results is warranted. Glioblastoma Radiotherapy Temozolomide Dose escalation Simultaneous integrated boost Medical physics. Medical radiology. Nuclear medicine Neoplasms. Tumors. Oncology. Including cancer and carcinogens Peter Wust verfasserin aut Reinhold Graf verfasserin aut Martin Misch verfasserin aut Julia Onken verfasserin aut Pirus Ghadjar verfasserin aut Harun Badakhshi verfasserin aut Julian Florange verfasserin aut Volker Budach verfasserin aut David Kaul verfasserin aut In Radiation Oncology BMC, 2006 13(2018), 1, Seite 9 (DE-627)508725739 (DE-600)2224965-5 1748717X nnns volume:13 year:2018 number:1 pages:9 https://doi.org/10.1186/s13014-018-1194-8 kostenfrei https://doaj.org/article/d236157f350e4dd89d5ea8dfcf20f719 kostenfrei http://link.springer.com/article/10.1186/s13014-018-1194-8 kostenfrei https://doaj.org/toc/1748-717X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2108 GBV_ILN_2111 GBV_ILN_2119 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2018 1 9
spelling	10.1186/s13014-018-1194-8 doi (DE-627)DOAJ038067838 (DE-599)DOAJd236157f350e4dd89d5ea8dfcf20f719 DE-627 ger DE-627 rakwb eng R895-920 RC254-282 Sebastian Zschaeck verfasserin aut Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background The dismal overall survival (OS) prognosis of glioblastoma, even after trimodal therapy, can be attributed mainly to the frequent incidence of intracranial relapse (ICR), which tends to present as an in-field recurrence after a radiation dose of 60 Gray (Gy). In this study, molecular marker-based prognostic indices were used to compare the outcomes of radiation with a standard dose versus a moderate dose escalation. Methods This retrospective analysis included 156 patients treated between 2009 and 2016. All patients were medically fit for postoperative chemoradiotherapy. In the dose-escalation cohort a simultaneous integrated boost of up to 66 Gy (66 Gy RT) within small high-risk volumes was applied. All other patients received daily radiation to a total dose of 60 Gy or twice daily to a total dose of 59.2 Gy (60 Gy RT). Results A total of 133 patients received standard 60 Gy RT, while 23 received 66 Gy RT. Patients in the 66 Gy RT group were younger (p < 0.001), whereas concomitant temozolomide use was more frequent in the 60 Gy RT group (p < 0.001). Other intergroup differences in known prognostic factors were not observed. Notably, the median time to ICR was significantly prolonged in the 66 Gy RT arm versus the 60 Gy RT arm (12.2 versus 7.6 months, p = 0.011), and this translated to an improved OS (18.8 versus 15.3 months, p = 0.012). A multivariate analysis revealed a strong association of 66 Gy RT with a prolonged time to ICR (hazard ratio = 0.498, p = 0.01) and OS (hazard ratio = 0.451, p = 0.01). These differences remained significant after implementing molecular marker-based prognostic scores (ICR p = 0.008, OS p = 0.007) and propensity-scored matched pairing (ICR p = 0.099, OS p = 0.023). Conclusion Radiation dose escalation was found to correlate with an improved time to ICR and OS in this cohort of glioblastoma patients. However, further prospective validation of these results is warranted. Glioblastoma Radiotherapy Temozolomide Dose escalation Simultaneous integrated boost Medical physics. Medical radiology. Nuclear medicine Neoplasms. Tumors. Oncology. Including cancer and carcinogens Peter Wust verfasserin aut Reinhold Graf verfasserin aut Martin Misch verfasserin aut Julia Onken verfasserin aut Pirus Ghadjar verfasserin aut Harun Badakhshi verfasserin aut Julian Florange verfasserin aut Volker Budach verfasserin aut David Kaul verfasserin aut In Radiation Oncology BMC, 2006 13(2018), 1, Seite 9 (DE-627)508725739 (DE-600)2224965-5 1748717X nnns volume:13 year:2018 number:1 pages:9 https://doi.org/10.1186/s13014-018-1194-8 kostenfrei https://doaj.org/article/d236157f350e4dd89d5ea8dfcf20f719 kostenfrei http://link.springer.com/article/10.1186/s13014-018-1194-8 kostenfrei https://doaj.org/toc/1748-717X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2108 GBV_ILN_2111 GBV_ILN_2119 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2018 1 9
allfields_unstemmed	10.1186/s13014-018-1194-8 doi (DE-627)DOAJ038067838 (DE-599)DOAJd236157f350e4dd89d5ea8dfcf20f719 DE-627 ger DE-627 rakwb eng R895-920 RC254-282 Sebastian Zschaeck verfasserin aut Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background The dismal overall survival (OS) prognosis of glioblastoma, even after trimodal therapy, can be attributed mainly to the frequent incidence of intracranial relapse (ICR), which tends to present as an in-field recurrence after a radiation dose of 60 Gray (Gy). In this study, molecular marker-based prognostic indices were used to compare the outcomes of radiation with a standard dose versus a moderate dose escalation. Methods This retrospective analysis included 156 patients treated between 2009 and 2016. All patients were medically fit for postoperative chemoradiotherapy. In the dose-escalation cohort a simultaneous integrated boost of up to 66 Gy (66 Gy RT) within small high-risk volumes was applied. All other patients received daily radiation to a total dose of 60 Gy or twice daily to a total dose of 59.2 Gy (60 Gy RT). Results A total of 133 patients received standard 60 Gy RT, while 23 received 66 Gy RT. Patients in the 66 Gy RT group were younger (p < 0.001), whereas concomitant temozolomide use was more frequent in the 60 Gy RT group (p < 0.001). Other intergroup differences in known prognostic factors were not observed. Notably, the median time to ICR was significantly prolonged in the 66 Gy RT arm versus the 60 Gy RT arm (12.2 versus 7.6 months, p = 0.011), and this translated to an improved OS (18.8 versus 15.3 months, p = 0.012). A multivariate analysis revealed a strong association of 66 Gy RT with a prolonged time to ICR (hazard ratio = 0.498, p = 0.01) and OS (hazard ratio = 0.451, p = 0.01). These differences remained significant after implementing molecular marker-based prognostic scores (ICR p = 0.008, OS p = 0.007) and propensity-scored matched pairing (ICR p = 0.099, OS p = 0.023). Conclusion Radiation dose escalation was found to correlate with an improved time to ICR and OS in this cohort of glioblastoma patients. However, further prospective validation of these results is warranted. Glioblastoma Radiotherapy Temozolomide Dose escalation Simultaneous integrated boost Medical physics. Medical radiology. Nuclear medicine Neoplasms. Tumors. Oncology. Including cancer and carcinogens Peter Wust verfasserin aut Reinhold Graf verfasserin aut Martin Misch verfasserin aut Julia Onken verfasserin aut Pirus Ghadjar verfasserin aut Harun Badakhshi verfasserin aut Julian Florange verfasserin aut Volker Budach verfasserin aut David Kaul verfasserin aut In Radiation Oncology BMC, 2006 13(2018), 1, Seite 9 (DE-627)508725739 (DE-600)2224965-5 1748717X nnns volume:13 year:2018 number:1 pages:9 https://doi.org/10.1186/s13014-018-1194-8 kostenfrei https://doaj.org/article/d236157f350e4dd89d5ea8dfcf20f719 kostenfrei http://link.springer.com/article/10.1186/s13014-018-1194-8 kostenfrei https://doaj.org/toc/1748-717X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2108 GBV_ILN_2111 GBV_ILN_2119 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2018 1 9
allfieldsGer	10.1186/s13014-018-1194-8 doi (DE-627)DOAJ038067838 (DE-599)DOAJd236157f350e4dd89d5ea8dfcf20f719 DE-627 ger DE-627 rakwb eng R895-920 RC254-282 Sebastian Zschaeck verfasserin aut Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background The dismal overall survival (OS) prognosis of glioblastoma, even after trimodal therapy, can be attributed mainly to the frequent incidence of intracranial relapse (ICR), which tends to present as an in-field recurrence after a radiation dose of 60 Gray (Gy). In this study, molecular marker-based prognostic indices were used to compare the outcomes of radiation with a standard dose versus a moderate dose escalation. Methods This retrospective analysis included 156 patients treated between 2009 and 2016. All patients were medically fit for postoperative chemoradiotherapy. In the dose-escalation cohort a simultaneous integrated boost of up to 66 Gy (66 Gy RT) within small high-risk volumes was applied. All other patients received daily radiation to a total dose of 60 Gy or twice daily to a total dose of 59.2 Gy (60 Gy RT). Results A total of 133 patients received standard 60 Gy RT, while 23 received 66 Gy RT. Patients in the 66 Gy RT group were younger (p < 0.001), whereas concomitant temozolomide use was more frequent in the 60 Gy RT group (p < 0.001). Other intergroup differences in known prognostic factors were not observed. Notably, the median time to ICR was significantly prolonged in the 66 Gy RT arm versus the 60 Gy RT arm (12.2 versus 7.6 months, p = 0.011), and this translated to an improved OS (18.8 versus 15.3 months, p = 0.012). A multivariate analysis revealed a strong association of 66 Gy RT with a prolonged time to ICR (hazard ratio = 0.498, p = 0.01) and OS (hazard ratio = 0.451, p = 0.01). These differences remained significant after implementing molecular marker-based prognostic scores (ICR p = 0.008, OS p = 0.007) and propensity-scored matched pairing (ICR p = 0.099, OS p = 0.023). Conclusion Radiation dose escalation was found to correlate with an improved time to ICR and OS in this cohort of glioblastoma patients. However, further prospective validation of these results is warranted. Glioblastoma Radiotherapy Temozolomide Dose escalation Simultaneous integrated boost Medical physics. Medical radiology. Nuclear medicine Neoplasms. Tumors. Oncology. Including cancer and carcinogens Peter Wust verfasserin aut Reinhold Graf verfasserin aut Martin Misch verfasserin aut Julia Onken verfasserin aut Pirus Ghadjar verfasserin aut Harun Badakhshi verfasserin aut Julian Florange verfasserin aut Volker Budach verfasserin aut David Kaul verfasserin aut In Radiation Oncology BMC, 2006 13(2018), 1, Seite 9 (DE-627)508725739 (DE-600)2224965-5 1748717X nnns volume:13 year:2018 number:1 pages:9 https://doi.org/10.1186/s13014-018-1194-8 kostenfrei https://doaj.org/article/d236157f350e4dd89d5ea8dfcf20f719 kostenfrei http://link.springer.com/article/10.1186/s13014-018-1194-8 kostenfrei https://doaj.org/toc/1748-717X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2108 GBV_ILN_2111 GBV_ILN_2119 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2018 1 9
allfieldsSound	10.1186/s13014-018-1194-8 doi (DE-627)DOAJ038067838 (DE-599)DOAJd236157f350e4dd89d5ea8dfcf20f719 DE-627 ger DE-627 rakwb eng R895-920 RC254-282 Sebastian Zschaeck verfasserin aut Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background The dismal overall survival (OS) prognosis of glioblastoma, even after trimodal therapy, can be attributed mainly to the frequent incidence of intracranial relapse (ICR), which tends to present as an in-field recurrence after a radiation dose of 60 Gray (Gy). In this study, molecular marker-based prognostic indices were used to compare the outcomes of radiation with a standard dose versus a moderate dose escalation. Methods This retrospective analysis included 156 patients treated between 2009 and 2016. All patients were medically fit for postoperative chemoradiotherapy. In the dose-escalation cohort a simultaneous integrated boost of up to 66 Gy (66 Gy RT) within small high-risk volumes was applied. All other patients received daily radiation to a total dose of 60 Gy or twice daily to a total dose of 59.2 Gy (60 Gy RT). Results A total of 133 patients received standard 60 Gy RT, while 23 received 66 Gy RT. Patients in the 66 Gy RT group were younger (p < 0.001), whereas concomitant temozolomide use was more frequent in the 60 Gy RT group (p < 0.001). Other intergroup differences in known prognostic factors were not observed. Notably, the median time to ICR was significantly prolonged in the 66 Gy RT arm versus the 60 Gy RT arm (12.2 versus 7.6 months, p = 0.011), and this translated to an improved OS (18.8 versus 15.3 months, p = 0.012). A multivariate analysis revealed a strong association of 66 Gy RT with a prolonged time to ICR (hazard ratio = 0.498, p = 0.01) and OS (hazard ratio = 0.451, p = 0.01). These differences remained significant after implementing molecular marker-based prognostic scores (ICR p = 0.008, OS p = 0.007) and propensity-scored matched pairing (ICR p = 0.099, OS p = 0.023). Conclusion Radiation dose escalation was found to correlate with an improved time to ICR and OS in this cohort of glioblastoma patients. However, further prospective validation of these results is warranted. Glioblastoma Radiotherapy Temozolomide Dose escalation Simultaneous integrated boost Medical physics. Medical radiology. Nuclear medicine Neoplasms. Tumors. Oncology. Including cancer and carcinogens Peter Wust verfasserin aut Reinhold Graf verfasserin aut Martin Misch verfasserin aut Julia Onken verfasserin aut Pirus Ghadjar verfasserin aut Harun Badakhshi verfasserin aut Julian Florange verfasserin aut Volker Budach verfasserin aut David Kaul verfasserin aut In Radiation Oncology BMC, 2006 13(2018), 1, Seite 9 (DE-627)508725739 (DE-600)2224965-5 1748717X nnns volume:13 year:2018 number:1 pages:9 https://doi.org/10.1186/s13014-018-1194-8 kostenfrei https://doaj.org/article/d236157f350e4dd89d5ea8dfcf20f719 kostenfrei http://link.springer.com/article/10.1186/s13014-018-1194-8 kostenfrei https://doaj.org/toc/1748-717X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2108 GBV_ILN_2111 GBV_ILN_2119 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2018 1 9
language	English
source	In Radiation Oncology 13(2018), 1, Seite 9 volume:13 year:2018 number:1 pages:9
sourceStr	In Radiation Oncology 13(2018), 1, Seite 9 volume:13 year:2018 number:1 pages:9
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Glioblastoma Radiotherapy Temozolomide Dose escalation Simultaneous integrated boost Medical physics. Medical radiology. Nuclear medicine Neoplasms. Tumors. Oncology. Including cancer and carcinogens
isfreeaccess_bool	true
container_title	Radiation Oncology
authorswithroles_txt_mv	Sebastian Zschaeck @@aut@@ Peter Wust @@aut@@ Reinhold Graf @@aut@@ Martin Misch @@aut@@ Julia Onken @@aut@@ Pirus Ghadjar @@aut@@ Harun Badakhshi @@aut@@ Julian Florange @@aut@@ Volker Budach @@aut@@ David Kaul @@aut@@
publishDateDaySort_date	2018-01-01T00:00:00Z
hierarchy_top_id	508725739
id	DOAJ038067838
language_de	englisch
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In this study, molecular marker-based prognostic indices were used to compare the outcomes of radiation with a standard dose versus a moderate dose escalation. Methods This retrospective analysis included 156 patients treated between 2009 and 2016. All patients were medically fit for postoperative chemoradiotherapy. In the dose-escalation cohort a simultaneous integrated boost of up to 66 Gy (66 Gy RT) within small high-risk volumes was applied. All other patients received daily radiation to a total dose of 60 Gy or twice daily to a total dose of 59.2 Gy (60 Gy RT). Results A total of 133 patients received standard 60 Gy RT, while 23 received 66 Gy RT. Patients in the 66 Gy RT group were younger (p < 0.001), whereas concomitant temozolomide use was more frequent in the 60 Gy RT group (p < 0.001). Other intergroup differences in known prognostic factors were not observed. Notably, the median time to ICR was significantly prolonged in the 66 Gy RT arm versus the 60 Gy RT arm (12.2 versus 7.6 months, p = 0.011), and this translated to an improved OS (18.8 versus 15.3 months, p = 0.012). A multivariate analysis revealed a strong association of 66 Gy RT with a prolonged time to ICR (hazard ratio = 0.498, p = 0.01) and OS (hazard ratio = 0.451, p = 0.01). These differences remained significant after implementing molecular marker-based prognostic scores (ICR p = 0.008, OS p = 0.007) and propensity-scored matched pairing (ICR p = 0.099, OS p = 0.023). Conclusion Radiation dose escalation was found to correlate with an improved time to ICR and OS in this cohort of glioblastoma patients. 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callnumber-first	R - Medicine
author	Sebastian Zschaeck
spellingShingle	Sebastian Zschaeck misc R895-920 misc RC254-282 misc Glioblastoma misc Radiotherapy misc Temozolomide misc Dose escalation misc Simultaneous integrated boost misc Medical physics. Medical radiology. Nuclear medicine misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma
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topic_title	R895-920 RC254-282 Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma Glioblastoma Radiotherapy Temozolomide Dose escalation Simultaneous integrated boost
topic	misc R895-920 misc RC254-282 misc Glioblastoma misc Radiotherapy misc Temozolomide misc Dose escalation misc Simultaneous integrated boost misc Medical physics. Medical radiology. Nuclear medicine misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
topic_unstemmed	misc R895-920 misc RC254-282 misc Glioblastoma misc Radiotherapy misc Temozolomide misc Dose escalation misc Simultaneous integrated boost misc Medical physics. Medical radiology. Nuclear medicine misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
topic_browse	misc R895-920 misc RC254-282 misc Glioblastoma misc Radiotherapy misc Temozolomide misc Dose escalation misc Simultaneous integrated boost misc Medical physics. Medical radiology. Nuclear medicine misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
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title	Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma
ctrlnum	(DE-627)DOAJ038067838 (DE-599)DOAJd236157f350e4dd89d5ea8dfcf20f719
title_full	Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma
author_sort	Sebastian Zschaeck
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author_browse	Sebastian Zschaeck Peter Wust Reinhold Graf Martin Misch Julia Onken Pirus Ghadjar Harun Badakhshi Julian Florange Volker Budach David Kaul
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title_sort	locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma
callnumber	R895-920
title_auth	Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma
abstract	Abstract Background The dismal overall survival (OS) prognosis of glioblastoma, even after trimodal therapy, can be attributed mainly to the frequent incidence of intracranial relapse (ICR), which tends to present as an in-field recurrence after a radiation dose of 60 Gray (Gy). In this study, molecular marker-based prognostic indices were used to compare the outcomes of radiation with a standard dose versus a moderate dose escalation. Methods This retrospective analysis included 156 patients treated between 2009 and 2016. All patients were medically fit for postoperative chemoradiotherapy. In the dose-escalation cohort a simultaneous integrated boost of up to 66 Gy (66 Gy RT) within small high-risk volumes was applied. All other patients received daily radiation to a total dose of 60 Gy or twice daily to a total dose of 59.2 Gy (60 Gy RT). Results A total of 133 patients received standard 60 Gy RT, while 23 received 66 Gy RT. Patients in the 66 Gy RT group were younger (p < 0.001), whereas concomitant temozolomide use was more frequent in the 60 Gy RT group (p < 0.001). Other intergroup differences in known prognostic factors were not observed. Notably, the median time to ICR was significantly prolonged in the 66 Gy RT arm versus the 60 Gy RT arm (12.2 versus 7.6 months, p = 0.011), and this translated to an improved OS (18.8 versus 15.3 months, p = 0.012). A multivariate analysis revealed a strong association of 66 Gy RT with a prolonged time to ICR (hazard ratio = 0.498, p = 0.01) and OS (hazard ratio = 0.451, p = 0.01). These differences remained significant after implementing molecular marker-based prognostic scores (ICR p = 0.008, OS p = 0.007) and propensity-scored matched pairing (ICR p = 0.099, OS p = 0.023). Conclusion Radiation dose escalation was found to correlate with an improved time to ICR and OS in this cohort of glioblastoma patients. However, further prospective validation of these results is warranted.
abstractGer	Abstract Background The dismal overall survival (OS) prognosis of glioblastoma, even after trimodal therapy, can be attributed mainly to the frequent incidence of intracranial relapse (ICR), which tends to present as an in-field recurrence after a radiation dose of 60 Gray (Gy). In this study, molecular marker-based prognostic indices were used to compare the outcomes of radiation with a standard dose versus a moderate dose escalation. Methods This retrospective analysis included 156 patients treated between 2009 and 2016. All patients were medically fit for postoperative chemoradiotherapy. In the dose-escalation cohort a simultaneous integrated boost of up to 66 Gy (66 Gy RT) within small high-risk volumes was applied. All other patients received daily radiation to a total dose of 60 Gy or twice daily to a total dose of 59.2 Gy (60 Gy RT). Results A total of 133 patients received standard 60 Gy RT, while 23 received 66 Gy RT. Patients in the 66 Gy RT group were younger (p < 0.001), whereas concomitant temozolomide use was more frequent in the 60 Gy RT group (p < 0.001). Other intergroup differences in known prognostic factors were not observed. Notably, the median time to ICR was significantly prolonged in the 66 Gy RT arm versus the 60 Gy RT arm (12.2 versus 7.6 months, p = 0.011), and this translated to an improved OS (18.8 versus 15.3 months, p = 0.012). A multivariate analysis revealed a strong association of 66 Gy RT with a prolonged time to ICR (hazard ratio = 0.498, p = 0.01) and OS (hazard ratio = 0.451, p = 0.01). These differences remained significant after implementing molecular marker-based prognostic scores (ICR p = 0.008, OS p = 0.007) and propensity-scored matched pairing (ICR p = 0.099, OS p = 0.023). Conclusion Radiation dose escalation was found to correlate with an improved time to ICR and OS in this cohort of glioblastoma patients. However, further prospective validation of these results is warranted.
abstract_unstemmed	Abstract Background The dismal overall survival (OS) prognosis of glioblastoma, even after trimodal therapy, can be attributed mainly to the frequent incidence of intracranial relapse (ICR), which tends to present as an in-field recurrence after a radiation dose of 60 Gray (Gy). In this study, molecular marker-based prognostic indices were used to compare the outcomes of radiation with a standard dose versus a moderate dose escalation. Methods This retrospective analysis included 156 patients treated between 2009 and 2016. All patients were medically fit for postoperative chemoradiotherapy. In the dose-escalation cohort a simultaneous integrated boost of up to 66 Gy (66 Gy RT) within small high-risk volumes was applied. All other patients received daily radiation to a total dose of 60 Gy or twice daily to a total dose of 59.2 Gy (60 Gy RT). Results A total of 133 patients received standard 60 Gy RT, while 23 received 66 Gy RT. Patients in the 66 Gy RT group were younger (p < 0.001), whereas concomitant temozolomide use was more frequent in the 60 Gy RT group (p < 0.001). Other intergroup differences in known prognostic factors were not observed. Notably, the median time to ICR was significantly prolonged in the 66 Gy RT arm versus the 60 Gy RT arm (12.2 versus 7.6 months, p = 0.011), and this translated to an improved OS (18.8 versus 15.3 months, p = 0.012). A multivariate analysis revealed a strong association of 66 Gy RT with a prolonged time to ICR (hazard ratio = 0.498, p = 0.01) and OS (hazard ratio = 0.451, p = 0.01). These differences remained significant after implementing molecular marker-based prognostic scores (ICR p = 0.008, OS p = 0.007) and propensity-scored matched pairing (ICR p = 0.099, OS p = 0.023). Conclusion Radiation dose escalation was found to correlate with an improved time to ICR and OS in this cohort of glioblastoma patients. However, further prospective validation of these results is warranted.
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title_short	Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma
url	https://doi.org/10.1186/s13014-018-1194-8 https://doaj.org/article/d236157f350e4dd89d5ea8dfcf20f719 http://link.springer.com/article/10.1186/s13014-018-1194-8 https://doaj.org/toc/1748-717X
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Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma

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