Principal Author, MDSecond Author, MD PhD
Third Author, MScInstitution, City, Country
23 January 2013
Glioblastoma Multiforme (GBM) is the most common primary brain malignant neoplasm in adults
Despite constant attempts to improve outcome, the survival of patients with GBM remains limited
Currently, the standard of care consists of maximal safe surgical resection followed by External Beam Radiotherapy (EBRT) and concomitant TMZ followed by adjuvant TMZ
Post-operative EBRT: 60 Gy/30 daily fractions over 6 weeks PTV margins extending to 2 to 2.5 cm from
oedema/residual disease and surgical cavity Dose response curve
Souhami, L. et al, 2004.•RTOG 9305 for SRS boost in addition to conventional EBRT
Laperrière, N. et al, 1998.•Interstitial Implant in addition to conventional EBRT
IMRT Concomitant boost technique
•Shorten overall treatment time: reduces accelerated repopulation•Larger dose/fraction: increases cell killing
MRI co-registration Immobilization Treatment delivery verification
IGRT Limited margins: reduce the normal brain volume
irradiated Reduction of treatment-related toxicity
Temozolomide XRT+Temozolomide Temozolomide Neo-adjuvant TMZ: 75 mg/m² QD will be administered
for 2 weeks before starting radiotherapy Accelerated Radiotherapy: 60 Gy in 20 fractions over
4 weeks using IMRT concomitant boost technique Concurrent TMZ with accelerated hypofractionated
radiotherapy: 75 mg/m² QD for the whole duration of radiotherapy
Adjuvant TMZ: 150 mg/m² QD for 5 consecutive days of a 28 day-cycle