dose escalation in GBM

[brendav]

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hi everyone - the michigan phase I/II dose escalation and Tanaka (Lancet Onc) studies seem to suggest that dose escalation beyond conventional 60 Gy may be feasible in GBM. are there any studies that suggest otherwise?

thanks,
brenda

 

[medgator]

hi everyone - the michigan phase I/II dose escalation and Tanaka (Lancet Onc) studies seem to suggest that dose escalation beyond conventional 60 Gy may be feasible in GBM. are there any studies that suggest otherwise?

thanks,
brenda

Feasible, perhaps. Effective? now that's going to be the question to answer.

 

[Palex80]

Feasible yet futile...

On a side note:
We had a 45 year old patient a couple of months ago, with a "tiny" GBM of 1.5 cm, who was symptomatic with seizures. Centrally located lesion, so the neurosurgeons didn't want to touch it, diagnosis was made by stereotactic biopsy, very little edema around the tumour.
Well, my colleague couldn't help NOT escalating, so he ended up giving the patient 54 Gy in conventional fractionation, followed by a radiosurgical boost of 12 Gy.

There is one negative randomized study on radiosurgical boost published. Time will tell how the patient does.

I personally think, that dose escalation will probably just change the pattern of recurrence. Patients are simply going to get their recurrent tumours around the high dose area and still die. Fighting GBM's and AstroIII's sucks...

 

[Gfunk6]

hi everyone - the michigan phase I/II dose escalation and Tanaka (Lancet Onc) studies seem to suggest that dose escalation beyond conventional 60 Gy may be feasible in GBM. are there any studies that suggest otherwise?

thanks,
brenda

By "feasible" do you mean "does not cause more brain necrosis than 60 Gy" or "improves OS or PFS?"

If the former, then the answer is probably not.

If the latter, then the answer is "not enough randomized, prospective data."

Rather than pure dose escalation through conventional fractionation, the field is moving towards intelligently boosting areas of "high risk" disease (e.g. choline/NAA ratio > 2) as defined by MRS; See this study and this protocol.

Also, eventually I think we will be hypofractionating our GBM pts more often. We already do this for our older, poorer KPS pts but I think it will also be adopted for better prognosis patients based on preliminary studies (see here).

 

[Palex80]

10 x 5 Gy!!! Are they nuts?

 

[Scatter]

Here's the latest from Colorado: http://www.sciencedirect.com/science/article/pii/S036030161200079X

60 Gy in 2 weeks with TMZ.

Now, that's having cajones! I remember my eyes bulging out when I was perusing the October issue of the Red Journal.

 

[seper]

Dose escalation in GBM has been studied quite extensively. Just stick to phase III data.

 

[Palex80]

Here's the latest from Colorado: http://www.sciencedirect.com/science/article/pii/S036030161200079X

60 Gy in 2 weeks with TMZ.

Now, that's having cajones! I remember my eyes bulging out when I was perusing the October issue of the Red Journal.

 

[Gfunk6]

Palex, maybe you and I should double-down and go 10 Gy x 6? Maybe we could treat the last day b.i.d. so that treatment within one week is possible. 😉

 

[Palex80]

Palex, maybe you and I should double-down and go 10 Gy x 6? Maybe we could treat the last day b.i.d. so that treatment within one week is possible. 😉

Excellent idea! Let's call this radiation therapy schedule "GG", stands for "Glioblastoma Grill".

I propose to combine this novel approach with the revival of an old surgical technique:
http://jama.jamanetwork.com/article.aspx?articleid=254927
Has anyone heard when the update of this JAMA paper is due to be published?
Is it still under review?

 

[Scatter]

Excellent idea! Let's call this radiation therapy schedule "GG", stands for "Glioblastoma Grill".

I propose to combine this novel approach with the revival of an old surgical technique:
http://jama.jamanetwork.com/article.aspx?articleid=254927
Has anyone heard when the update of this JAMA paper is due to be published?
Is it still under review?

Buahahaha!! Love the GG!