Radiotherapy For High-grade Glioma Research Articles

Comparative dosimetric study of radiotherapy in high-grade gliomas based on the guidelines of EORTC and NRG-2019 target delineation.

Radiotherapy is one of the most important treatments for high-grade glioma (HGG), but the best way to delineate the target areas for radiotherapy remains controversial, so our aim was to compare the dosimetric differences in radiation treatment plans generated based on the European Organization for Research and Treatment of Cancer (EORTC) and National Research Group (NRG) consensus to provide evidence for optimal target delineation for HGG. We prospectively enrolled 13 patients with a confirmed HGG from our hospital and assessed dosimetric differences in radiotherapy treatment plans generated according to the EORTC and NRG-2019 guidelines. For each patient, two treatment plans were generated. Dosimetric parameters were compared by dose-volume histograms for each plan. The median volume for planning target volume (PTV) of EORTC plans, PTV1 of NRG-2019 plans, and PTV2 of NRG-2019 plans were 336.6 cm3 (range, 161.1-511.5 cm3), 365.3 cm3 (range, 123.4-535.0 cm3), and 263.2 cm3 (range, 116.8-497.7 cm3), respectively. Both treatment plans were found to have similar efficiency and evaluated as acceptable for patient treatment. Both treatment plans showed well conformal index and homogeneity index and were not statistically significantly different (P = 0.397 and P = 0.427, respectively). There was no significant difference in the volume percent of brain irradiated to 30, 46, and 60 Gy according to different target delineations (P = 0.397, P = 0.590, and P = 0.739, respectively). These two plans also showed no significant differences in the doses to the brain stem, optic chiasm, left and right optic nerves, left and right lens, left and right eyes, pituitary, and left and right temporal lobes (P = 0.858, P = 0.858, P = 0.701 and P = 0.794, P = 0.701 and P = 0.427, P = 0.489 and P = 0.898, P = 0.626, and P = 0.942 and P = 0.161, respectively). The NRG-2019 project did not increase the dose of organs at risk (OARs) radiation. This is a significant finding that further lays the groundwork for the application of the NRG-2019 consensus in the treatment of patients with HGGs. The effect of radiotherapy target area and glial fibrillary acidic protein (GFAP) on the prognosis of high-grade glioma and its mechanism, number ChiCTR2100046667. Registered 26 May 2021.

A Randomized Trial of Comparative Dosimetric Study of Radiotherapy in High Grade Gliomas Based on the Guidelines of 2019-NRG and EORTC Target Delineation

<h3>Purpose/Objective(s)</h3> Postoperative radiotherapy is important for high-grade glioma (WHO Grade 3-4), but the optimal way for contouring the target area for radiotherapy is still unclear. The purpose of this randomized trial was to compare the dosimetric differences in radiation treatment plans (TPS) generated based on the European Organization for Research and Treatment of Cancer (EORTC) and NRG consensus (NRG-2019) guidelines to provide evidence for optimal target delineation for high-grade glioma. <h3>Materials/Methods</h3> Patients with diagnosis of high-grade glioma were randomly assigned (1:1) to receive postoperative radiotherapy based on either EORTC guideline or NRG-2019 guideline. We report the result of dosimetric comparison first. In 13 high grade glioma patients, both EORTC and NRG-2019 radiation treatment plans were generated for dosimetric comparison. For EORTC group, the prescription dose was 95% PTV 60 Gy in 30 fractions. The gross tumor volume (GTV) including resection cavity and residual tumor encompassed the T1-weighted images (T1WI) and T2 FLAIR contrast-enhancing lesion. For NRG-2019group, GTV involved the T1-weighted images (T1WI) and T2 FLAIR contrast-enhancing foci and peritumoral edema on the preoperative CT or MRI. The prescription dose of PTV1 was 46 Gy in 23 fractions. The areas were then diminished to contain merely the contrast enhancing foci with a 2.5 cm margin as CTV2, and PTV2 was equal the CTV2 plus 0.3 cm margin for additional prescription dose was 14 Gy in 7 fractions. It should be noted that CTV1 and CTV2 were trimmed according to the anatomical barriers, falx, ventricles, etc. This trial is registered with chictr.org.cn, number ChiCTR2100046667. <h3>Results</h3> The median volume for PTV of EORTC plans, PTV1 of NRG-2019 plans, PTV2 of NRG-2019 plans were 336.6 cm³ (range 161.1-511.5 cm³), 365.3 cm³ (range 123.4-535.0 cm³), and 263.2 cm³ (range 116.8-497.7 cm³), respectively. Both treatment plans were found to have similar efficiency and evaluated as acceptable for patient treatment. Both treatment plans showed well conformal index and homogeneity index and were not statistically significantly different. There was no significant difference in the volume percent of brain irradiated to 30 Gy, 46 Gy, and 60 Gy according to different target delineations (P = 0.397, P = 0.590 and P = 0.739, respectively). These two plans also showed no significant differences in the doses to the brainstem, optic chiasm, optic nerve, lens, eyes, pituitary, and temporal lobes (P = 0.858, P = 0.858, 0.701, P = 0.794, P = 0.701, P = 0.427, P = 0.489, P = 0.898, P = 0.626, P = 0.942 and P = 0.161, respectively). <h3>Conclusion</h3> Compared with EORTC guidelines for postoperative radiotherapy for high-grade glioma, the NRG-2019 target area delineation guidelines were able to include peritumor edema in the CTV without increasing the radiation dose to organs at risk (OARs). This study further provides a foundation for the application of the NRG-2019 consensus in radiotherapy for patients with high-grade gliomas.

Low-Dose Apatinib Improves the Prognosis of Patients with Recurrent High-Grade Gliomas.

Objective To evaluate the efficacy, safety, and prognostic value of low-dose apatinib in combination with temozolomide in the treatment of primary or recurrent high-grade gliomas (HGGs). Methods A retrospective analysis of patients with postoperative and recurrent HGGs treated in our hospital from April 1, 2018, to April 30, 2020. Patients should be treated by combination therapy (surgery + radiotherapy + chemotherapy). Patients who received apatinib combined with temozolomide chemotherapy were allocated to the research group (RG), while patients who received temozolomide chemotherapy alone were allocated to the control group (CG). The efficacy and toxic side effects were compared between the two groups. Results There were 67 qualified patients retrieved, including 37 cases in the RG and 30 cases in the CG. There were no significant differences in objective remission rate (ORR) or disease control rate (DCR) between the control group and the study group (P > 0.05). However, the overall improvement of clinical efficacy in the observation group was better than that in the control group (P < 0.05). There was no significant difference in the incidence of adverse effects between the two groups (P > 0.05). There were no significant differences in overall survival (OS) or progression-free survival (PFS) between the two groups (P > 0.05). Conclusion Low-dose apatinib combined with temozolomide and radiotherapy for HGGs is effective in improving efficacy, relieving brain edema, reducing the use of glucocorticoid drugs, and improving patients' quality of life. It has mild adverse effects and is well tolerated by patients.

Magnetic Resonance Spectroscopy in Diagnosis and Follow-Up of Gliomas: State-of-the-Art.

Simple SummaryMagnetic resonance spectroscopy (MRS) is a useful technique in diagnosis and follow-up of gliomas. In this review we provide an insight in the use of both proton and phosphorous MRS in clinical and scientific every day practice.Preoperative grade prediction is important in diagnostics of glioma. Even more important can be follow-up after chemotherapy and radiotherapy of high grade gliomas. In this review we provide an overview of MR-spectroscopy (MRS), technical aspects, and different clinical scenarios in the diagnostics and follow-up of gliomas in pediatric and adult populations. Furthermore, we provide a recap of the current research utility and possible future strategies regarding proton- and phosphorous-MRS in glioma research.

FGL2 expression and relation with survival and prognosis in patients treated with concurrent temozolamide and radiotherapy in high-grade glioma.

e14019 Background: FGL2 is a member of the fibrinogen-related protein, Literature suggests that FGL2 contributes to the progression of glioblastoma multiforme (GBM) through inducing multiple immunosuppression mechanisms. The present study aimed at evaluation of the expression and the prognostic value of FGL2 in high grade glioma. Methods: In our study, we analysed sixty specimens retrieved at diagnosis of high grade glioma patients. They received concurrent Temozolamide and radiotherapy, as a standard of care, during the period from October 2019 to December 2020 and and were followed up for 12 months . Evaluation of FGL2 expression done by using FGL2 Immunohistochemistry .ClinicalTrials.gov Identifier: NCT04113278. Results: Mean age of studied patients was (48.88± 12.45) . Majority (75%) of patients were males. Mean FGL2 expression was 61 ± 31.80 (%) with range between 3% and 95%. It was found that 7 (11.7%) patients had negative FGL2. Over the period of follow up, incidence of disease progression was significantly higher among the patients with higher percentage of FGL2 in comparison to those with lower FGL2 percentages (76.54 ± 18.52 vs. 56.17 ± 33.41(%); P= 0.04). number of deaths was also significantly higher among the high FGL2 percentage group (64.86 ± 31.58 vs. 54.16 ± 31.71(%); P= 0.03). Intensity of FGL2 was mild 16 (26.7%), moderate 20 (33.3%) and strong 17 (28.3%) . Intensity of FGL2 was more among patients with disease progression. All patients with progression had either moderate intensity (46.2%) or strong intensity (53.8%). Seven (14.9%) patients without disease progression had negative FGL2 expression with ( P= 0.01). Disease free progression (DFP) was significantly negatively correlated with increasing in the intensity of FGL2. Patients with strong intensity had the lowest DFP (14 month) while patients with negative FGL2 and mild intensity had the highest DFP (25 month) with ( P &lt;0.001). Overall survival was significantly worse with increasing in the intensity of FGL2 where patients with strong intensity had the lowest overall survival (19 month), while patients with negative FGL2 and mild intensity had the highest overall survival (27and 26 month, respectively) with ( P &lt;0.001). For prediction of progression among patients with high grade glioma, FGL2 at cut off point &gt; 60% has 92.3% sensitivity and 28% specificity with ( P= 0.04). For prediction of mortality among patients with high grade glioma, FGL2 at cut off point &gt; 70% has 67% sensitivity and 61% specificity with ( P= 0.03). Conclusions: FGL2 expression in high grade glioma patients can be used as a prognostic factor but additional studies are required to clarify the prognostic value.

PD-0483 Long-lasting anti-tumor immunity with conventional and FLASH radiotherapy of high grade glioma

PD-0483 Long-lasting anti-tumor immunity with conventional and FLASH radiotherapy of high grade glioma

Radiotherapy of High-Grade Gliomas: First Half of 2021 Update with Special Reference to Radiosensitization Studies.

Albeit the effort to develop targeted therapies for patients with high-grade gliomas (WHO grades III and IV) is evidenced by hundreds of current clinical trials, radiation remains one of the few effective therapeutic options for them. This review article analyzes the updates on the topic “radiotherapy of high-grade gliomas” during the period 1 January 2021–30 June 2021. The high number of articles retrieved in PubMed using the search terms (“gliom* and radio*”) and manually selected for relevance indicates the feverish research currently ongoing on the subject. During the last semester, significant advances were provided in both the preclinical and clinical settings concerning the diagnosis and prognosis of high-grade gliomas, their radioresistance, and the inevitable side effects of their treatment with radiation. The novel information concerning tumor radiosensitization was of special interest in terms of therapeutic perspective and was discussed in detail.

A prospective interventional study evaluating seizure activity during a radiotherapy course for high-grade gliomas (SURF-ROGG)

BackgroundGliomas are often associated with symptoms including seizures. Most patients with high-grade gliomas are treated with radiotherapy or radio-chemotherapy. Since irradiation causes inflammation, it may initially aggravate symptoms. Studies focusing on seizure activity during radiotherapy for gliomas are not available. Such knowledge may improve patient monitoring and anti-epileptic treatment. This study evaluates seizure activity during radiotherapy for high-grade gliomas.MethodsThe primary objective this prospective interventional study is the evaluation of seizure activity during a course of radiotherapy for high-grade gliomas. Progression of seizure activity is defined as increased frequency of seizures by > 50%, increased severity of seizures, or initiation/increase by ≥25% of anti-epileptic medication. Seizure frequency up to 6 weeks following radiotherapy and electroencephalography activity typical for epilepsy will also be evaluated. Patients keep a seizure diary during and up to 6 weeks following radiotherapy. Every day, they will document number (and type) of seizures and anti-epileptic medication. Once a week, the findings of the diary are checked and discussed with a neurologist to initiate or adjust anti-epileptic medication, if necessary. Patients complete a questionnaire regarding their satisfaction with the seizure diary. If the dissatisfaction rate is > 40%, the seizure diary will be considered not suitable for the investigated indication. Thirty-five patients (32 patients plus drop-outs) should be enrolled. With this sample size, a one-sample binomial test with a one-sided significance level of 2.5% has a power of 80% to yield statistical significance, if the rate of patients with progression of seizure activity is 30% (rate under the alternative hypothesis), assuming a ‘natural’ background progression-rate of 10% without radiotherapy (null hypothesis).DiscussionIf an increase in seizure activity during a course of radiotherapy for high-grade glioma occurs, the findings of this study may pave the way for a larger prospective trial and will likely lead to closer patient monitoring and better anti-epileptic treatment.Trial registrationclinicaltrials.gov (NCT04552756); registered on 16th of September, 2020.

Narrative review of palliative hypofractionated radiotherapy for high grade glioma.

High grade gliomas (HGG) include World Health Organization (WHO) grade III anaplastic astrocytoma (AA) and WHO grade IV glioblastoma (GBM). As genomic alterations are prognostic, even WHO grade II, IDH-wildtype gliomas may be considered as HGG. Current management of HGG include best supportive care (BSC), surgery, radiation therapy (RT), chemotherapy, and a combination. Elderly patients (defined here as age ≥65) with GBM have significantly worse survival compared to younger patients. Similarly, patients with poor performance status [defined as Karnofsky performance status (KPS) <60 or ECOG performance status (PS) >2], regardless of age have worse outcomes. The standard of care for treatment of HGG involves surgery and chemoradiation. However, the optimal treatment in terms of efficacy, safety and maintaining quality of life (QoL), remains a matter of debate in the elderly and/or poor performing patients due to their worse prognosis. Less aggressive interventions are usually reserved for these patients despite surgery providing a survival and neurologic benefit. Improved survival has been noted in elderly patients treated with RT in comparison with those receiving best supportive care (BSC) alone, with similar survival for patients undergoing standard RT (60 Gy/30 fractions) and hypofractionated RT (25-40 Gy in 5-15 daily fractions). An alkylating agent, temozolomide (TMZ), represents a safe and effective option in select patients with promoter methylation of O6-methylguanine-DNA-methyltransferase (MGMT) gene. A recent phase III randomized trial for GBM patients (age ≥65 years, ECOG PS 0-2) demonstrated a significant improvement in progression-free survival (PFS) and overall survival (OS) with hypofractionated RT (40 Gy/15 fractions) with concurrent and adjuvant TMZ vs. RT alone, without adversely impacting either QoL or functional status. Despite chemoradiation becoming the recommended treatment in GBM patients who are elderly but fit, several questions remain unanswered. This includes the survival impact of chemoradiation in patients with severe comorbidities or with ECOG PS >2 or a combination of poor prognostic features such as male gender, poor neurocognition, biopsy only and lack of MGMT methylation. Personalized management of patients with HGG is warranted in the modern era as we attempt to balance the benefit of efficacious treatment with potential toxicity while appreciating the many nuances associated with multiple prognostic factors on anticipated survival. Here, we aim to review the palliative management options available for HGG patients with an emphasis on the role of RT.

Effect H2 Water on QoL of Patients Receiving Radiotherapy for High Grade Gliomas.

Effect H2 Water on QoL of Patients Receiving Radiotherapy for High Grade Gliomas.

Dosimetric Comparison of Simultaneous Integrated vs. Sequential Boost in Radiotherapy for High Grade Gliomas

To compare the dosimetric coverage of the Planning target volumes (PTV) and sparing organs at risk (OARs) in volumetric modulated arc therapy (VMAT) technique for high grade glioma using different methods to Boost the tumor bed by sequential boost (SEB) vs. simultaneous integrated boost (SIB).

OA18 - Proton and Carbon-ion Radiotherapy for High Grade Glioma: Early Results of the Shanghai Proton and Heavy Ion Center (SPHIC)

OA18 - Proton and Carbon-ion Radiotherapy for High Grade Glioma: Early Results of the Shanghai Proton and Heavy Ion Center (SPHIC)

EP-1211: High-dose vs conventional radiotherapy for high-grade glioma: A propensity score-matched analysis

EP-1211: High-dose vs conventional radiotherapy for high-grade glioma: A propensity score-matched analysis

Predictive biomarkers of resistance to hypofractionated radiotherapy in high grade glioma

BackgroundRadiotherapy plays a major role in the management of high grade glioma. However, the radioresistance of glioma cells limits its efficiency and drives recurrence inside the irradiated tumor volume leading to poor outcome for patients. Stereotactic hypofractionated radiotherapy is one option for recurrent high grade gliomas. Optimization of hypofractionated radiotherapy with new radiosensitizing agents requires the identification of robust druggable targets involved in radioresistance.MethodsWe generated 11 xenografted glioma models: 6 were derived from cell lines (1 WHO grade III and 5 grade IV) and 5 were patient derived xenografts (2 WHO grade III and 3 grade IV). Xenografts were treated by hypofractionated radiotherapy (6x5Gy). We searched for 89 biomarkers of radioresistance (39 total proteins, 26 phosphoproteins and 24 ratios of phosphoproteins on total proteins) using Reverse Phase Protein Array.ResultsBoth type of xenografted models showed equivalent spectrum of sensitivity and profile of response to hypofractionated radiotherapy. We report that Phospho-EGFR/EGFR, Phospho-Chk1/Chk1 and VCP were associated to resistance to hypofractionated radiotherapy.ConclusionsSeveral compounds targeting EGFR or CHK1 are already in clinical use and combining them with stereotactic hypofractionated radiotherapy for recurrent high grade gliomas might be of particular interest.

Valproic acid reduces hair loss and improves survival in patients receiving temozolomide-based radiation therapy for high-grade glioma.

Valproic acid (VPA), a histone deacetylase (HDAC) inhibitor, is also used to manage seizures in glioblastoma patients. HDAC inhibitors can protect normal cells and tissues from the deleterious effects of radiotherapy, and VPA is reported to improve the survival of glioblastoma patients receiving chemoradiation therapy. VPA also promotes hair growth, and thus has the potential to reduce the radiotherapy side effect of hair loss while improving the survival of patients with glioblastoma. The purpose of this study was to determine whether VPA use during radiotherapy for high-grade glioma is associated with decreased side effects of radiotherapy and an improvement in overall survival (OS) and progression-free survival (PFS). Medical records of 112 patients with high-grade glioma were retrospectively reviewed. We grouped patients by VPA use or non-use during radiotherapy, and evaluated hair loss, OS, and PFS. The radiation dose and fractionation at the onset of hair loss were 4Gy and two fractions higher, respectively, in the VPA group compared with the VPA non-use group (P<0.01). Median OS was 42.2 and 20.3months in the VPA use and non-use groups, respectively (P<0.01; hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.18-0.74). Median PFS was 22.7 and 11.0months in the VPA use and non-use groups, respectively (P=0.099; HR, 0.62; 95% CI, 0.36-1.09). VPA use during radiotherapy for glioma is associated with delayed hair loss and improvement in survival. Hair loss prevention benefits patients suffering from the deleterious effects of radiation.

Comparison of dose distributions hippocampus in high grade gliomas irradiation with linac-based imrt and volumetric arc therapy: a dosimetric study.

The aim of this study was to assess the feasibility of sparing contralateral hippocampus during partial brain radiotherapy in high grade gliomas. 20 previously treated patients were replanned to 60 Gy in 30 fractions with sparing intensity-modulated radiotherapy (IMRT) and volumetric modulated arctherapy (VMAT) using the following planning objectives: 100 % of PTV covered by 95% isodose without violating organs at risk (OAR) and hot spot dose constraints. For each, standard intensity-modulated radiotherapy (IMRT) plans were generated, as well as sparing IMRT and VMAT plans which spared contralateral (hemispheric cases) hippocampus. When the three plans were compared, there was equivalent PTV coverage, homogeneity, and conformality. Sparing IMRT significantly reduced maximum, mean, V20, V30 and V40 hippocampus doses compared with standart IMRT and VMAT (p < 0.05). VMAT significantly reduced maximum left lens and mean eye doses compared with standart IMRT and sparing IMRT (p < 0.05). Brainstem, chiasm, left and right optic nerves, right eyes and lens doses were similar. VMAT significantly reduced monitor units compared with standart IMRT and sparing IMRT (p < 0.05). It is possible to spare contralateral hippocampus during PBRT for high grade gliomas using IMRT. This approach may reduce late cognitive sequelae of cranial radiotherapy.

Radiotherapy of high-grade gliomas: current standards and new concepts, innovations in imaging and radiotherapy, and new therapeutic approaches

The current standards in radiotherapy of high-grade gliomas (HGG) are based on anatomic imaging techniques, usually computed tomography (CT) scanning and magnetic resonance imaging (MRI). The guidelines vary depending on whether the HGG is a histological grade 3 anaplastic glioma (AG) or a grade 4 glioblastoma multiforme (GBM). For AG, T2-weighted MRI sequences plus the region of contrast enhancement in T1 are considered for the delineation of the gross tumor volume (GTV), and an isotropic expansion of 15 to 20 mm is recommended for the clinical target volume (CTV). For GBM, the Radiation Therapy Oncology Group favors a two-step technique, with an initial phase (CTV1) including any T2 hyperintensity area (edema) plus a 20 mm margin treated with up to 46 Gy in 23 fractions, followed by a reduction in CTV2 to the contrast enhancement region in T1 with an additional 25 mm margin. The European Organisation of Research and Treatment of Cancer recommends a single-phase technique with a unique GTV, which comprises the T1 contrast enhancement region plus a margin of 20 to 30 mm. A total dose of 60 Gy in 30 fractions is usually delivered for GBM, and a dose of 59.4 Gy in 33 fractions is typically given for AG. As more than 85% of HGGs recur in field, dose-escalation studies have shown that 70 to 75 Gy can be delivered in 6 weeks with relevant toxicities developing in < 10% of the patients. However, the only randomized dose-escalation trial, in which the boost dose was guided by conventional MRI, did not show any survival advantage of this treatment over the reference arm. HGGs are amongst the most infiltrative and heterogeneous tumors, and it was hypothesized that the most highly aggressive areas were missed; thus, better visualization of these high-risk regions for radiation boost could decrease the recurrence rate. Innovations in imaging and linear accelerators (LINAC) could help deliver the right doses of radiation to the right subvolumes according to the dose-painting concept. Advanced imaging techniques provide functional information on cellular density (diffusion MRI), angiogenesis (perfusion MRI), metabolic activity and cellular proliferation [positron emission tomography (PET) and magnetic resonance spectroscopy (MRS)]. All of these non-invasive techniques demonstrated good association between the images and histology, with up to 40% of HGGs functionally presenting a high activity within the non-contrast-enhanced areas in T1. New LINAC technologies, such as intensity-modulated and stereotactic radiotherapy, help to deliver a simultaneous integrated boost (SIB) > 60 Gy. Trials delivering a SIB into a biological GTV showed the feasibility of this treatment, but the final results, in terms of clinical benefits for HGG patients, are still pending. Many issues have been identified: the variety of MRI and PET machines (and amino-acid tracers), the heterogeneity of the protocols used for image acquisition and post-treatment, the geometric distortion and the unreliable algorithms for co-registration of brain anatomy with functional maps, and the semi-quiescent but highly invasive HGG cells. These issues could be solved by the homogenization of the protocols and software applications, the simultaneous acquisition of anatomic and functional images (PET-MRI machines), the combination of complementary imaging tools (perfusion and diffusion MRI), and the concomitant addition of some ad hoc targeted drugs against angiogenesis and invasiveness to chemoradiotherapy. The integration of these hybrid data will construct new synthetic metrics for fully individualized treatments.

Dosimetric comparison of three dimensional conformal radiotherapy and intensity modulated radiotherapy in high grade gliomas

Dosimetric comparison of three dimensional conformal radiotherapy and intensity modulated radiotherapy in high grade gliomas Treatment of high-grade gliomas continues to be frustrating for the clinician as the medial survival stands at a dismal 14.5 months for glioblastoma multiforme (GBM) with the current standard of care. Given the high dose and generous margins required to be irradiated, three dimensional conformal radiotherapy (3DCRT) has become standard practice. Radiation dose escalation beyond 60 Gy, by means of stereotactic or intensity modulated radiotherapy (IMRT) boost, has not yielded clinically significant benefits in terms of local control or survival. At the same time, the potential of IMRT to spare normal tissues such as the brain stem and the optic apparatus makes it an attractive tool for modern radiation oncologists in seeking to improve post-radiotherapy quality of life. At our centre, we have been treating a large number of cases of high grade glioma with 3DCRT and IMRT for the last several years. The present study has been an effort to understand any potential benefits that IMRT, even without dose escalation, can offer.

Outcome of Patients Undergoing Radiotherapy for High Grade Glioma While Taking the Histone Deacetylase Inhibitor, Valproic Acid

In preclinical studies, histone deacetylase (HDAC) inhibitors have demonstrated radiosensitizing capabilities. However, no clinical data exists to support the use of HDAC inhibitors with radiotherapy (RT). Valproic acid (VA) is an HDAC inhibitor sometimes used to prevent or treat seizures in patients with CNS neoplasms. The purpose of this study was to assess the outcome of patients using VA during RT for high grade gliomas.

18F Fluoroethyltyrosine-Positron Emission Tomography-guided Radiotherapy for High-grade Glioma

18F Fluoroethyltyrosine-Positron Emission Tomography-guided Radiotherapy for High-grade Glioma