Skip to main content
SpringerLink
Log in

External beam and conformal radiotherapy in the management of gliomas

  • Conference paper
Local Therapies for Glioma Present Status and Future Developments

Part of the book series: Acta Neurochirurgica Supplements ((NEUROCHIRURGICA,volume 88))

Abstract

External beam radiotherapy remains an important local treatment modality in both high and low grade gliomas, however its contribution to outcome remains modest. In high grade tumours this is because of their extreme clinical radioresistance, with local recurrences occurring even after doses over 70 Gy. In low grade tumours radiation does not seem to alter the overall pattern of disease progression significantly. Therefore despite use of the new technologies now available that allow radiotherapy to be delivered more accurately and to higher doses, local control of these tumours is still rarely achieved. Unfortunately these tumours have not proven sensitive to changes in radiotherapy fractionation or to the addition of radio-sensitising agents. Novel approaches to these tumours are needed, based on an improved understanding of both tumour and normal tissue response to radiation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adams EJ, Cosgrove VP, Shepherd SF, Warrington AP, Bedford JL, Mubata CD, Bidmead AM, Brada M (1999) Comparison of a multi-leaf collimator with conformal blocks for the delivery of stereotactically guided conformal radiotherapy. Radiother Oncol 51: 205–209

    Article  PubMed  CAS  Google Scholar 

  2. Ang K (1999) Clinical application of laboratory data on neurotoxicity. Front Radiat Ther Oncol 33: 253–264

    Article  PubMed  CAS  Google Scholar 

  3. Armstrong CL, Hunter JV, Ledakis GE, Cohen B, Tallent EM, Goldstein BH, Tochner Z, Lustig R, Judy KD, Pruitt A, Moll-man JE, Stanczak EM, Jo MY, Than TL, Phillips P (2002) Late cognitive and radiographic changes related to radiotherapy: initial prospective findings. Neurology 59: 40–48

    PubMed  CAS  Google Scholar 

  4. Benczik J, Tenhunen M, Snellman M, Joensuu H, Farkkila M, Joensuu R, Abo Ramadan U, Kallio M, deGritz B, Morris GM, Hopewell JW (2002) Late radiation effects in the dog brain: correlation of MRI and histological changes. Radiother Oncol 63: 107–120

    Article  PubMed  Google Scholar 

  5. Bleehen NM, Stenning SP (1991) 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 64: 769–774

    Article  PubMed  CAS  Google Scholar 

  6. Chan JL, Lee SW, Fraass BA, Normolle DP, Greenberg HS, Junck LR, Gebarski SS, Sandler HM (2002) Survival and failure patterns of high-grade gliomas after three-dimensional conformal radiotherapy. J Clin Oncol 20: 1635–1642

    Article  PubMed  Google Scholar 

  7. Chang EL, Loeffler JS, Riese NE, Wen PY, Alexander E 3rd, Black PM, Coleman CN (1998) Survival results from a phase I study of etanidazole (SR2508) and radiotherapy in patients with malignant glioma. Int J Radiat Oncol Biol Phys 40: 65–70

    Article  PubMed  CAS  Google Scholar 

  8. Corn BW, Yousem DM, Scott CB, Rotman M, Asbell SO, Nelson DF, Martin L, Curran WJ Jr (1994) White matter changes are correlated significantly with radiation dose. Observations from a randomized dose-escalation trial for malignant glioma (Radiation Therapy Oncology Group 83–02). Cancer 74: 83–02

    Article  PubMed  CAS  Google Scholar 

  9. Crosby TD, Melcher AA, Wetherall S, Brockway S, Burnet NG (1998) A comparison of two planning techniques for radiotherapy of high grade astrocytomas. Clin Oncol (R Coll Radio]) 10: 392–398

    Article  CAS  Google Scholar 

  10. Curran WJ Jr, Scott CB, Horton J, Nelson JS, Weinstein AS, Fischbach AJ, Chang CH, Rotman M, Asbell SO, Krisch RE et al (1993) Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst 85: 704–710

    Article  PubMed  Google Scholar 

  11. Deutsch M, Green SB, Strike TA, Burger PC, Robertson JT, Selker RG, Shapiro WR, Mealey J Jr, Ransohoff J 2nd, Paoletti P et al (1989) Results of a randomized trial comparing BCNU plus radiotherapy, streptozotocin plus radiotherapy, BCNU plus hyperfractionated radiotherapy, and BCNU following misonidazole plus radiotherapy in the postoperative treatment of malignant glioma. Int J Radiat Oncol Biol Phys 16: 1389–1396

    Article  PubMed  CAS  Google Scholar 

  12. Faithfull S, Brada M (1998) Somnolence syndrome in adults following cranial irradiation for primary brain tumours. Clin Oncol (R Coll Radiol) 10: 250–254

    Article  CAS  Google Scholar 

  13. Fallai C, Olmi P (1997) Hyperfractionated and accelerated radiation therapy in central nervous system tumors (malignant gliomas, pediatric tumors, and brain metastases). Radiother Oncol 43: 235–246

    Article  PubMed  CAS  Google Scholar 

  14. Fulton DS, Urtasun RC, Shin KH, Geggie PH, Thomas H, Muller PJ, Moody J, Tanasichuk H, Mielke B, Johnson E et al (1984) Misonidazole combined with hyperfractionation in the management of malignant glioma. Int J Radiat Oncol Biol Phys 10: 1709–1712

    Article  PubMed  CAS  Google Scholar 

  15. Huncharek M (1998) Meta-analytic re-evaluation of misonidazole in the treatment of high grade astrocytoma. Anticancer Res 18: 1935–1939

    PubMed  CAS  Google Scholar 

  16. Jansen EP, Dewit LG, van Herk M, Bartelink H (2000) Target volumes in radiotherapy for high-grade malignant glioma of the brain. Radiother Oncol 56: 151–156

    Article  PubMed  CAS  Google Scholar 

  17. Jeremic B, Bamberg M (2001) Radiation therapy for incompletely resected supratentorial low-grade glioma in adults. J Neurooncol 55: 101–112

    Article  PubMed  CAS  Google Scholar 

  18. Johannesen TB, Rasmussen K, Winther FO, Halvorsen U, Lote K (2002) Late radiation effects on hearing, vestibular function, and taste in brain tumor patients. Int J Radiat Oncol Biol Phys 53: 86–90

    Article  PubMed  Google Scholar 

  19. Karim AB, Afra D, Cornu P, Bleehan N, Schraub S, De Witte O, Darcel F, Stenning S, Pierart M, Van Glabbeke M (2002) Randomized trial on the efficacy of radiotherapy for cerebral low-grade glioma in the adult: European Organization for Research and Treatment of Cancer Study 22845 with the Medical Research Council study BRO4: an interim analysis. Int J Radiat Oncol Biol Phys 52: 316–324

    Article  PubMed  Google Scholar 

  20. Karim AB, Maat B, Hatlevoll R, Menten J, Rutten EH, Thomas DG, Mascarenhas F, Horiot JC, Parvinen LM, van Reijn M, Jager JJ, Fabrini MG, van Alphen AM, Hamers HP, Gaspar L, Noordman E, Pierart M, van Glabbeke M (1996) A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844. Int J Radiat On-col Biol Phys 36: 549–556

    Article  CAS  Google Scholar 

  21. Khoo VS, Oldham M, Adams EJ, Bedford JL, Webb S, Brada M (1999) Comparison of intensity-modulated tomotherapy with stereotactically guided conformal radiotherapy for brain tumors. Int J Radiat Oncol Biol Phys 45: 415–425

    PubMed  CAS  Google Scholar 

  22. Knisely J (2002) Conformal radiotherapy for high-grade gliomas: how much is too much? J Clin Oncol 20: 3357–3358; author reply 3359

    Google Scholar 

  23. Kristiansen K, Hagen S, Kollevold T, Torvik A, Holme I, Nesbakken R, Hatlevoll R, Lindgren M, Brun A, Lindgren S, Notter G, Andersen AP, Elgen K (1981) 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 47: 649–652

    Article  PubMed  CAS  Google Scholar 

  24. Laing RW, Warrington AP, Graham J, Britton J, Hines F, Brada M (1993) Efficacy and toxicity of fractionated stereotactic radiotherapy in the treatment of recurrent gliomas (phase I/II study). Radiother Oncol 27: 22–29

    Article  PubMed  CAS  Google Scholar 

  25. Lammering G, Valerie K, Lin PS, Mikkelsen RB, Contessa JN, Feden JP, Farnsworth J, Dent P, Schmidt-Ullrich RK (2001) Radiosensitization of malignant glioma cells through over-expression of dominant-negative epidermal growth factor receptor. Clin Cancer Res 7: 682–690

    PubMed  CAS  Google Scholar 

  26. Lee SW, Fraass BA, Marsh LH, Herbort K, Gebarski SS, Martel MK, Radany EH, Lichter AS, Sandler HM (1999) Patterns of failure following high-dose 3-D conformal radiotherapy for high-grade astrocytomas: a quantitative dosimetric study. Int J Radiat Oncol Biol Phys 43: 79–88

    Article  PubMed  CAS  Google Scholar 

  27. Levin VA, Yung WK, Bruner J, Kyritsis A, Leeds N, Gleason MJ, Hess KR, Meyers CA, Ictech SA, Chang E, Maor MH (2000) Phase II study of accelerated fractionation radiation therapy with carboplatin followed by PCV chemotherapy for the treatment of anaplastic gliomas. Int J Radiat Oncol Biol Phys 53: 58–66

    Google Scholar 

  28. Loeffler JS, Kooy HM, Tarbell NJ (1999) The emergence of conformal radiotherapy: special implications for pediatric neuro-oncology. Int J Radiat Oncol Biol Phys 44: 237–238

    Article  PubMed  CAS  Google Scholar 

  29. Lund EL, Bastholm L, Kristjansen PE (2000) Therapeutic synergy of TNP-470 and ionizing radiation: effects on tumor growth, vessel morphology, and angiogenesis in human glioblastoma multiforme xenografts. Clin Cancer Res 6: 971–978

    PubMed  CAS  Google Scholar 

  30. Marks JE, Baglan RJ, Prassad SC, Blank WF (1981) Cerebral radionecrosis: incidence and risk in relation to dose, time, fractionation and volume. Int J Radiat Oncol Biol Phys 7: 243–252

    Article  PubMed  CAS  Google Scholar 

  31. Miralbell R, Morrsex F, Greiner R, Bolla M, Storme G, Hulshof M, Bernier J, Denekamp J, Rojas AM, Pierart M, van Glabbeke M, Mirimanoff RO (1999) Accelerated radiotherapy, carbogen, and nicotinamide in glioblastoma multiforme: report of European Organization for Research and Treatment of Cancer trial 22933. J Clin Oncol 17: 3143–3149

    PubMed  CAS  Google Scholar 

  32. Nakagawa K, Aoki Y, Fujimaki T, Tago M, Terahara A, Karasawa K, Sakata K, Sasaki Y, Matsutani M, Akanuma A (1998) High-dose conformal radiotherapy influenced the pattern of failure but did not improve survival in glioblastoma multiforme. Int J Radiat Oncol Biol Phys 40: 1141–1149

    Article  PubMed  CAS  Google Scholar 

  33. Nelson DF, Nelson JS, Davis DR, Chang CH, Griffin TW, Pajak TF (1985) Survival and prognosis of patients with astrocytoma with atypical or anaplastic features. J Neurooncol 3: 99–103

    Article  PubMed  CAS  Google Scholar 

  34. Oppitz U, Maessen D, Zunterer H, Richter S, Flentje M (1999) 3D-recurrence-patterns of glioblastomas after CT-planned postoperative irradiation. Radiother Oncol 53: 53–57

    Article  PubMed  CAS  Google Scholar 

  35. Overgaard J (1994) Clinical evaluation of nitroimidazoles as modifiers of hypoxia in solid tumors. Oncol Res 6: 509–518

    PubMed  CAS  Google Scholar 

  36. Panten T, Hoss A, Bohsung J, Becker G, Sroka-Perez G (1999) Time requirements in conformal radiotherapy treatment planning. Radiother Oncol 51: 211–214

    Article  PubMed  CAS  Google Scholar 

  37. Postma TJ, Klein M, Verstappen CC, Bromberg JE, Swennen M, Langendijk JA, Taphoorn MJ, Scheltens P, Slotman BJ, van der Ploeg HM, Aaronson NK, Heimans JJ (2002) Radiotherapy-induced cerebral abnormalities in patients with low-grade glioma. Neurology 59: 121–123

    PubMed  CAS  Google Scholar 

  38. Prados MD, Scott C, Sandler H, Buckner JC, Phillips T, Schultz C, Urtasun R, Davis R, Gutin P, Cascino TL, Greenberg HS, Curran WJ Jr (1999) A phase 3 randomized study of radiotherapy plus procarbazine, CCNU, and vincristine (PCV) with or without BUdR for the treatment of anaplastic astrocytoma: a preliminary report of RTOG 9404. Int J Radiat Oncol Biol Phys 45: 1109–1115

    Article  PubMed  CAS  Google Scholar 

  39. Saran FH, Baumert BG, Khoo VS, Adams EJ, Garre ML, Warrington AP, Brada M (2002) Stereotactically guided conformal radiotherapy for progressive low-grade gliomas of childhood. Int J Radiat Oncol Biol Phys 53: 43–51

    Article  PubMed  Google Scholar 

  40. Schultheiss TE, Kun LE, Ang KK, Stephens LC (1995) Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys 31: 1093–1112

    Article  PubMed  CAS  Google Scholar 

  41. Shapiro WR, Green SB, Burger PC, Mahaley MS Jr, Selker RG, VanGilder JC, Robertson JT, Ransohoff J, Mealey J Jr, Strike TA et al (1989) 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 71: 1–9

    Article  PubMed  CAS  Google Scholar 

  42. Shaw E, Arusell R, Scheithauer B, O’Fallon J, O’Neill B, Dina-poli R, Nelson D, Earle J, Jones C, Cascino T, Nichols D, Ivnik R, Hellman R, Curran W, Abrams R (2002) Prospective randomized trial of low-versus high-dose radiation therapy in adults with supratentorial low-grade glioma: initial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study. J Clin Oncol 20: 2267–2276

    Article  PubMed  CAS  Google Scholar 

  43. Shin KH, Muller PJ, Geggie PH (1983) Superfractionation radiation therapy in the treatment of malignant astrocytoma. Cancer 52: 2040–2043

    Article  PubMed  CAS  Google Scholar 

  44. Silverman CL, Palkes H, Talent B, Kovnar E, Clouse JW, Thomas PR (1984) Late effects of radiotherapy on patients with cerebellar medulloblastoma. Cancer 54: 825–829

    Article  PubMed  CAS  Google Scholar 

  45. Steen RG, Koury BSM, Granja CI, Xiong X, Wu S, Glass JO, Mulhern RK, Kun LE, Merchant TE (2001) Effect of ionizing radiation on the human brain: white matter and gray matter T1 in pediatric brain tumor patients treated with conformal radiation therapy. Int J Radiat Oncol Biol Phys 49: 79–91

    Article  PubMed  CAS  Google Scholar 

  46. Stupp R, Dietrich PY, Ostermann Kraljevic S, Pica A, Maillard I, Maeder P, Meuli R, Janzer R, Pizzolato G, Miralbell R, Porchet F, Regli L, de Tribolet N, Mirimanoff RO, Leyvraz S (2002) Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol 20: 1375–1382

    Article  PubMed  CAS  Google Scholar 

  47. Thilmann C, Zabel A, Grosser KH, Hoess A, Wannenmacher M, Debus J (2001) Intensity-modulated radiotherapy with an integrated boost to the macroscopic tumor volume in the treatment of high-grade gliomas. Int J Cancer 96: 341–349

    Article  PubMed  CAS  Google Scholar 

  48. Thomas R, James N, Guerrero D, Ashley S, Gregor A, Brada M (1994) Hypofractionated radiotherapy as palliative treatment in poor prognosis patients with high grade glioma. Radiother Onco133: 113–116

    Google Scholar 

  49. Walker MD, Alexander E Jr, Hunt WE, MacCarty CS, Mahaley MS Jr, Mealey J Jr, Norrell HA, Owens G, Ransohoff J, Wilson CB, Gehan EA, Strike TA (1978) Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 49: 333–343

    Article  PubMed  CAS  Google Scholar 

  50. Walker MD, Strike TA, Sheline GE (1979) An analysis of dose-effect relationship in the radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys 5: 1725–1731

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mount Vernon Cancer Centre and The Gray Cancer Institute, Northwood, Middlesex, UK

    S.C. Short

Authors
  1. S.C. Short
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

    M. Westphal

  2. Neurochirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Germany

    J.-C. Tonn

  3. Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel

    Z. Ram

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer-Verlag/Wien

About this paper

Cite this paper

Short, S. (2003). External beam and conformal radiotherapy in the management of gliomas. In: Westphal, M., Tonn, JC., Ram, Z. (eds) Local Therapies for Glioma Present Status and Future Developments. Acta Neurochirurgica Supplements, vol 88. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6090-9_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-6090-9_7

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-40355-6

  • Online ISBN: 978-3-7091-6090-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation