Abstract
Postoperative external beam radiotherapy was considered the standard adjuvant treatment for patients with glioblastoma multiforme until the advent of using the drug temozolomide (TMZ) in addition to radiotherapy. High-dose volume should be focal, minimizing whole brain irradiation. Modern imaging, using several magnetic resonance sequences, has improved the planning target volume definition. The total dose delivered should be in the range of 60 Gy in fraction sizes of 1.8-2.0 Gy. Currently, TMZ concomitant and adjuvant to radiotherapy has become the standard of care for glioblastoma multiforme patients. Radiotherapy dose-intensification and radiosensitizer approaches have not improved the outcome. In spite of the lack of high quality evidence, stereotactic radiotherapy can be considered for a selected group of patients. For elderly patients, data suggest that the same survival benefit can be achieved with similar morbidity using a shorter course of radiotherapy (hypofractionation). Elderly patients with tumors that exhibit methylation of the O-6-methylguanine-DNA methyltransferase promoter can benefit from TMZ alone.
Highlights
Postoperative external beam radiotherapy was considered the standard adjuvant treatment for patients with glioblastoma multiforme until the advent of using the drug temozolomide (TMZ) in addition to radiotherapy
Postoperative external beam radiotherapy with concomitant and adjuvant TMZ is the standard of care for patients with glioblastoma multiforme (GBM)
The total dose delivered should be in the range of 60 Gy in fraction sizes of 1.8–2.0 Gy
Summary
Five trials demonstrated a statistically significant survival benefit from postoperative radiotherapy compared with supportive care only www.cjcsysu.com. Chemoradiotherapy for glioblastoma multiforme or with different chemotherapy schedules without radiotherapy[5]. The 5 positive trials were well balanced with respect to the major prognostic factors such as age and baseline Karnofsky performance status (KPS). The value of radiotherapy in elderly patients was demonstrated retrospectively[7]. A French randomized trial that compared radiotherapy with best supportive care in GBM patients 70 years or older confirmed a better outcome when radiotherapy was used. Median survival following a radiotherapy of 50 Gy over 5 weeks was 29.1 weeks compared with 16.9 weeks when supportive care only was given. Radiotherapy did not impair cognition or quality of life[8]
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