Abstract
The role of radiation therapy in the management of high-grade gliomas was established by a series of prospective randomized trials. Subsequently, numerous attempts to improve outcomes with dose escalation, radiation sensitizers, neutrons, and brachytherapy have been unsuccessful. The lack of success with these approaches may be a consequence of poor target volume definition, tumor repopulation, or innate radioresistance. Until recently, the role of chemotherapy in the management of glioblastoma multiforme was unclear, but a large phase III randomized trial conclusively demonstrated a survival advantage of temozolomide delivered concurrently with radiation and in the adjuvant setting. The role of chemotherapy in the management of anaplastic astrocytoma and anaplastic oliodendroglioma remains to be defined. Current focus is on the identification of molecular pathways unique to high-grade gliomas that may serve as targets for future therapeutic agents.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Walker MD, Alexander E, Jr, Hunt WE, et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 1978;49(3):333–343.
Kristiansen K, Hagen S, Kollevold T, et al. Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: a prospective multicenter trial of the Scandinavian Glioblastoma Study Group. Cancer 1981;47(4):649–652.
Andersen AP. Postoperative irradiation of glioblastomas. Results in a randomized series. Acta Radiol Oncol Radiat Phys Biol 1978;17(6):475–484.
Laperriere N, Zuraw L, Cairncross G, Cancer Care Ontario Practice Guidelines Initiative Neuro-Oncology Disease Site G. Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review. Radiother Oncol 2002;64(3):259–273.
Walker MD, Strike TA, Sheline GE. An analysis of dose-effect relationship in the radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys 1979;5(10):1725–1731.
Bleehen NM, Stenning SP. A Medical Research Council trial of two radiotherapy doses in the treatment of grades 3 and 4 astrocytoma. The Medical Research Council Brain Tumour Working Party. Br J Cancer 1991; 64(4):769–774.
Phillips C, Guiney M, Smith J, Hughes P, Narayan K, Quong G. A randomized trial comparing 35Gy in ten fractions with 60Gy in 30 fractions of cerebral irradiation for glioblastoma multiforme and older patients with anaplastic astrocytoma. Radiother Oncol 2003;68(1):23–26.
Kelly PJ, Daumas-Duport C, Kispert DB, Kall BA, Scheithauer BW, Illig JJ. Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasms. J Neurosurg 1987;66(6):865–874.
Hochberg FH, Pruitt A. Assumptions in the radiotherapy of glioblastoma. Neurology 1980;30(9):907–911.
Shapiro WR, Green SB, Burger PC, et al. Randomized trial of three chemotherapy regimens and two radiotherapy regimens and two radiotherapy regimens in postoperative treatment of malignant glioma. Brain Tumor Cooperative Group Trial 8001. J Neurosurg 1989;71(1):1–9.
Chan JL, Lee SW, Fraass BA, et al. Survival and failure patterns of high-grade gliomas after three-dimensional conformal radiotherapy. J Clin Oncol 2002;20(6):1635–1642.
Pirzkall A, McKnight TR, Graves EE, et al. MR-spectroscopy guided target delineation for high-grade gliomas. Int J Radiat Oncol Biol Phys 2001;50(4):915–928.
Graves EE, Nelson SJ, Vigneron DB, et al. A preliminary study of the prognostic value of proton magnetic resonance spectroscopic imaging in gamma knife radiosurgery of recurrent malignant gliomas. Neurosurgery 2000;46(2):319–326; discussion 26-28.
Jacobs AH, Winkler A, Dittmar C, et al. Molecular and functional imaging technology for the development of efficient treatment strategies for gliomas. Technol Cancer Res Treat 2002;1(3):187–204.
Chen WCT, Kamdar N. Imaging gliomas with FDOPA and FLT, compared with FDG. In: Society of Nuclear Medicine 2004.
Hall E. Radiobiology for the Radiobiologist, 5th Ed. Philadelphia: Lippincott Williams & Wilkins; 2000.
Overgaard J. Clinical evaluation of nitroimidazoles as modifiers of hypoxia in solid tumors. Oncol Res 1994;6(10–11):509–518.
Kleinberg L, Grossman SA, Carson K, et al. Survival of patients with newly diagnosed glioblastoma multiforme treated with RSR13 and radiotherapy: results of a phase II new approaches to brain tumor therapy CNS consortium safety and efficacy study. J Clin Oncol 2002;20(14):3149–3155.
Schulz CA MM, Badie B, et al. Continuous 28 day iododeoxyuridine infusion and hyperfractionated accelerated radiotherapy for malignant glioma: A phase I clinical study. Int J Radiat Oncol Biol Phys 2004;59(4):1007–1115.
Prados MD, Scott CB, Rotman M, et al. Influence of bromodeoxyuridine radiosensitization on malignant glioma patient survival: a retrospective comparison of survival data from the Northern California Oncology Group (NCOG) and Radiation Therapy Oncology Group trials (RTOG) for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 1998;40(3):653–659.
Ford J SW, Mehta MP, et al. Comparison of survival of patients in the phase I study of Motexafin Gadolinium (MGd) with radiation therapy (RT) for glioblastoma multiforme (GBM), with a matched cohort of patients from the RTOG RPA glioma data base. In: American Society of Clinical Oncology; 2003.
Stupp R MP, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomittant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005;352:987–996.
Barker FG 2nd, Simmons ML, Chang SM, et al. EGFR overexpression and radiation response in glioblastoma multiforme. Int J Radiat Oncol Biol Phys 2001;51(2):410–418.
Seiferheld W, Chakravarti A, Ang KK, et al. Overexpression of the epidermal growth factor receptor (EGFR), as determined by EGFR immunostaining on tissue microarrays, fails to demonstrate prognostic value for patients with glioblastoma multiforme: a report from RTOG 7401, 7918, 8302, 8409, 9006, 9305, 9602, and 9806. IInt J Radiat Oncol Biol Phys 2002;54(2 Supp 1):96.
Buckner JC AK, Ballman K, et al. Immunohistochemical detection of EGFRvIII and prognostic significance in patients with malignant glioma enrolled in NCCTG clinical trials. In: American Society of Clinical Oncology; 2004.
Huang SM, Harari PM. Modulation of radiation response after epidermal growth factor receptor blockade in squamous cell carcinomas: inhibition of damage repair, cell cycle kinetics, and tumor angiogenesis. Clin Cancer Res 2000;6(6):2166–2174.
Chakravarti A, Dicker A, Mehta M. The contribution of epidermal growth factor receptor (EGFR) signaling pathway to radioresistance in human gliomas: a review of preclinical and correlative clinical data. Int J Radiat Oncol Biol Phys 2004;58(3):927–931.
Werner-Wasik M, Scott CB, Nelson DF, et al. Final report of a phase I/II trial of hyperfractionated and accelerated hyperfractionated radiation therapy with carmustine for adults with supratentorial malignant gliomas. Radiation Therapy Oncology Group Study 83-02. Cancer 1996;77(8):1535–1543.
Souhami L SW, Brachman D, et al. Randomized comparison of radiosurgery followed by conventional radiotherapy with carmustine to conventional radiotherapy with carmustine for patients with Glioblastoma multiforme: Report of Radiation Therapy Oncology Group 93-05 protocol. Int J Radiat Oncol Phys 2004;60(3):853–860.
Laperriere NJ, Leung PM, McKenzie S, et al. Randomized study of brachytherapy in the initial management of patients with malignant astrocytoma. Int J Radiat Oncol Biol Phys 1998;41(5):1005–1011.
Selker RG, Shapiro WR, Burger P, et al. The Brain Tumor Cooperative Group NIH Trial 87-01: a randomized comparison of surgery, external radiotherapy, and carmustine versus surgery, interstitial radiotherapy boost, external radiation therapy, and carmustine. Neurosurgery 2002;51(2):343–355; discussion 55-57.
Curran WJ, Jr., Scott CB, Horton J, et al. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. [see comment]. J Natl Cancer Inst 1993;85(9):704–710.
Laramore GE, Martz KL, Nelson JS, Griffin TW, Chang CH, Horton J. Radiation Therapy Oncology Group (RTOG) survival data on anaplastic astrocytomas of the brain: does a more aggressive form of treatment adversely impact survivalInt J Radiat Oncol Biol Phys 1989;17(6):1351–1356.
Cairncross JG, Ueki K, Zlatescu MC, et al. Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst 1998;90(19):1473–1479.
Cairncross J SW, Shaw E, et al. An intergroup randomized controlled clinical trial (RCT) of chemotherapy plus radiation (RT) versus RT alone for pure and mixed anaplastic oligodendrogliomas: Initial report of RTOG 94-02. In: American Society of Clinical Oncology 2004.
Chinot OL, Honore S, Dufour H, et al. Safety and efficacy of temozolomide in patients with recurrent anaplastic oligodendrogliomas after standard radiotherapy and chemotherapy. J Clin Oncol 2001;19(9):2449–2455.
Shapiro WR, Young DF. Treatment of malignant glioma. A controlled study of chemotherapy and irradiation. Arch Neurol 1976;33(7):494–450.
Sandberg-Wollheim M, Malmstrom P, Stromblad LG, et al. A randomized study of chemotherapy with procarbazine, vincristine, and lomustine with and without radiation therapy for astrocytoma grades 3 and/or 4. Cancer 1991;68(1):22–29.
Walker MD, Green SB, Byar DP, et al. Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med 1980;303(23):1323–1329.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Humana Press Inc., Totowa, NJ
About this chapter
Cite this chapter
Shah, H.K., Mehta, M.P. (2007). Radiation Therapy. In: Barnett, G.H. (eds) High-Grade Gliomas. Current Clinical Oncology. Humana Press. https://doi.org/10.1007/978-1-59745-185-7_13
Download citation
DOI: https://doi.org/10.1007/978-1-59745-185-7_13
Publisher Name: Humana Press
Print ISBN: 978-1-58829-511-8
Online ISBN: 978-1-59745-185-7
eBook Packages: MedicineMedicine (R0)