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The role of radiation in treating glioblastoma: here to stay

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Abstract

Despite numerous efforts over the past several decades, few therapeutic breakthroughs in the treatment of GBM have been realized, and even these have yielded only incrementally modest gains. Radiotherapy remains a crucial component in the management of this disease. In this review, the historical basis for inclusion of radiotherapy as part of the therapeutic regimen for GBM is examined. Additionally, an overview of the evidence supporting the modern role of radiotherapy is provided along with a discussion of standard and emerging combined modality therapies. Finally, GBM management guidelines from three professional societies are reviewed.

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References

  1. Walker MD et al (1976) Evaluation of mithramycin in the treatment of anaplastic gliomas. J Neurosurg 44(6):655–667

    Article  CAS  PubMed  Google Scholar 

  2. Walker MD et al (1978) Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 49(3):333–343

    Article  CAS  PubMed  Google Scholar 

  3. Walker MD et al (1980) Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med 303(23):1323–1329

    Article  CAS  PubMed  Google Scholar 

  4. 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(10):1725–1731

    Article  CAS  PubMed  Google Scholar 

  5. Shapiro WR 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):1–9

    Article  CAS  PubMed  Google Scholar 

  6. Hochberg FH, Pruitt A (1980) Assumptions in the radiotherapy of glioblastoma. Neurology 30(9):907–911

    Article  CAS  PubMed  Google Scholar 

  7. Wallner KE et al (1989) Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 16(6):1405–1409

    Article  CAS  PubMed  Google Scholar 

  8. Garden AS et al (1991) Outcome and patterns of failure following limited-volume irradiation for malignant astrocytomas. Radiother Oncol 20(2):99–110

    Article  CAS  PubMed  Google Scholar 

  9. Liang BC et al (1991) Malignant astrocytomas: focal tumor recurrence after focal external beam radiation therapy. J Neurosurg 75(4):559–563

    Article  CAS  PubMed  Google Scholar 

  10. Levin VA et al (1990) Superiority of post-radiotherapy adjuvant chemotherapy with CCNU, procarbazine, and vincristine (PCV) over BCNU for anaplastic gliomas: NCOG 6G61 final report. Int J Radiat Oncol Biol Phys 18(2):321–324

    Article  CAS  PubMed  Google Scholar 

  11. Eyre HJ et al (1983) Randomized comparisons of radiotherapy and CCNU versus radiotherapy, CCNU plus procarbazine for the treatment of malignant gliomas following surgery. A Southwest Oncology Group Report. J Neurooncol 1(3):171–177

    Article  CAS  PubMed  Google Scholar 

  12. Chang CH et al (1983) Comparison of postoperative radiotherapy and combined postoperative radiotherapy and chemotherapy in the multidisciplinary management of malignant gliomas. A joint Radiation Therapy Oncology Group and Eastern Cooperative Oncology Group study. Cancer 52(6):997–1007

    Article  CAS  PubMed  Google Scholar 

  13. Newlands ES et al (1992) Phase I trial of temozolomide (CCRG 81045: M&B 39831: NSC 362856). Br J Cancer 65(2):287–291

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. O’Reilly SM et al (1993) Temozolomide: a new oral cytotoxic chemotherapeutic agent with promising activity against primary brain tumours. Eur J Cancer 29A(7):940–942

    Article  PubMed  Google Scholar 

  15. Bower M et al (1997) Multicentre CRC phase II trial of temozolomide in recurrent or progressive high-grade glioma. Cancer Chemother Pharmacol 40(6):484–488

    Article  CAS  PubMed  Google Scholar 

  16. Yung WK et al (1999) Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse. Temodal Brain Tumor Group. J Clin Oncol 17(9):2762–2771

    Article  CAS  PubMed  Google Scholar 

  17. Newlands ES et al (1996) The Charing Cross Hospital experience with temozolomide in patients with gliomas. Eur J Cancer 32A(13):2236–2241

    Article  CAS  PubMed  Google Scholar 

  18. Yung WK et al (2000) A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer 83(5):588–593

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Tolcher AW et al (2003) Marked inactivation of O6-alkylguanine-DNA alkyltransferase activity with protracted temozolomide schedules. Br J Cancer 88(7):1004–1011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. van Rijn J et al (2000) Survival of human glioma cells treated with various combination of temozolomide and X-rays. Int J Radiat Oncol Biol Phys 47(3):779–784

    Article  PubMed  Google Scholar 

  21. Stupp R et al (2002) Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol 20(5):1375–1382

    Article  CAS  PubMed  Google Scholar 

  22. Stupp R et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996

    Article  CAS  PubMed  Google Scholar 

  23. Stupp R et al (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10(5):459–466

    Article  CAS  PubMed  Google Scholar 

  24. Keime-Guibert F et al (2007) Radiotherapy for glioblastoma in the elderly. N Engl J Med 356(15):1527–1535

    Article  CAS  PubMed  Google Scholar 

  25. Roa W et al (2004) Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol 22(9):1583–1588

    Article  CAS  PubMed  Google Scholar 

  26. Roa W et al (2015) International Atomic Energy Agency randomized phase III study of radiation therapy in elderly and/or frail patients with newly diagnosed glioblastoma multiforme. J Clin Oncol 33(35):4145–4150

    Article  PubMed  Google Scholar 

  27. Malmstrom A et al (2012) Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol 13(9):916–926

    Article  PubMed  Google Scholar 

  28. Wick W et al (2012) Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Oncol 13(7):707–715

    Article  CAS  PubMed  Google Scholar 

  29. Perry JR et al. (2016) A phase III randomized controlled trial of short-course radiotherapy with or without concomitant and adjuvant temozolomide in elderly patients with glioblastoma. J Clin Oncol. ASCO Annual Meeting Abstract #LBA2

  30. Kole AJ et al (2016) Concurrent chemoradiotherapy versus radiotherapy alone for “biopsy-only” glioblastoma multiforme. Cancer 122(15):2364–2370

    Article  CAS  PubMed  Google Scholar 

  31. Hodi FS et al (2010) Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med 363(8):711–723

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Kantoff PW et al (2010) Sipuleucel-T immunotherapy for castration-resistant prostate cancer. N Engl J Med 363(5):411–422

    Article  CAS  PubMed  Google Scholar 

  33. Grupp SA et al (2013) Chimeric antigen receptor-modified T cells for acute lymphoid leukemia. N Engl J Med 368(16):1509–1518

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Brahmer JR et al (2012) Safety and activity of anti-PD-L1 antibody in patients with advanced cancer. N Engl J Med 366(26):2455–2465

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Chow KK et al (2015) Combining immunotherapy with radiation for the treatment of glioblastoma. J Neurooncol 123(3):459–464

    Article  CAS  PubMed  Google Scholar 

  36. Reardon DA et al. (2015) ReACT: overall survival from a randomized phase II study of rindopepimut (CDX-110) plus bevacizumab in relapsed glioblastoma. In 2015 ASCO Annual Meeting

  37. Ciccia A, Elledge SJ (2010) The DNA damage response: making it safe to play with knives. Mol Cell 40(2):179–204

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Bassi C et al (2013) Nuclear PTEN controls DNA repair and sensitivity to genotoxic stress. Science 341(6144):395–399

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Mukherjee B et al (2009) EGFRvIII and DNA double-strand break repair: a molecular mechanism for radioresistance in glioblastoma. Cancer Res 69(10):4252–4259

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Squatrito M, Holland EC (2011) DNA damage response and growth factor signaling pathways in gliomagenesis and therapeutic resistance. Cancer Res 71(18):5945–5949

    Article  CAS  PubMed  Google Scholar 

  41. Ahmed SU et al (2015) Selective inhibition of parallel DNA damage response pathways optimizes radiosensitization of glioblastoma stem-like cells. Cancer Res 75(20):4416–4428

    Article  CAS  PubMed  Google Scholar 

  42. Aziz K et al (2012) Targeting DNA damage and repair: embracing the pharmacological era for successful cancer therapy. Pharmacol Ther 133(3):334–350

    Article  CAS  PubMed  Google Scholar 

  43. Curtin NJ (2012) DNA repair dysregulation from cancer driver to therapeutic target. Nat Rev Cancer 12(12):801–817

    Article  CAS  PubMed  Google Scholar 

  44. Huhn D, Bolck HA, Sartori AA (2013) Targeting DNA double-strand break signalling and repair: recent advances in cancer therapy. Swiss Med Wkly 143:w13837

    PubMed  Google Scholar 

  45. National Comprehensive Cancer Network (2016) Anaplastic gliomas/glioblastoma (version 1.2016). https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf. Accessed 28 July 2016

  46. Cabrera AR et al (2016) Radiation therapy for glioblastoma: executive summary of an American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline. Pract Radiat Oncol 6(4):217–225

    Article  PubMed  Google Scholar 

  47. Stupp R et al. (2014) High-grade glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 25(Suppl 3):iii93–iii101

    Article  PubMed  Google Scholar 

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Correspondence to Minesh P. Mehta.

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Conflict of interest

Christopher D. Corso has received consulting honorarium from Elekta. Ranjit S. Bindra declares that he/she has no conflict of interest. Minesh P. Mehta has received consulting honorarium from Varian, Agenus, INSYS, and Remedy. Minesh P. Mehta has also received research funding from Novocure.

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This article does not contain any studies with human participants performed by any of the authors.

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Corso, C.D., Bindra, R.S. & Mehta, M.P. The role of radiation in treating glioblastoma: here to stay. J Neurooncol 134, 479–485 (2017). https://doi.org/10.1007/s11060-016-2348-x

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  • DOI: https://doi.org/10.1007/s11060-016-2348-x

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