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The role of radiation therapy in treatment of adults with newly diagnosed glioblastoma multiforme: a systematic review and evidence-based clinical practice guideline update

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Abstract

Target population

These recommendations apply to adult patients diagnosed with newly diagnosed glioblastoma.

Question 1

In adult patients (aged 65 and under) with newly diagnosed glioblastoma, is the addition of radiation therapy (RT) more beneficial than management without RT in improving survival?

Recommendations

Level I: Radiation therapy (RT) is recommended for the treatment of newly diagnosed malignant glioblastoma in adults.

Question 2

In adult patients (aged 65 and under) with newly diagnosed glioblastoma, is the RT regimen of 60 Gy given in 2 Gy daily fractions more beneficial than alternative regimens in providing survival benefit while minimizing toxicity?

Recommendations

Level I: Treatment schemes should include dosage of up to 60 Gy given in 2 Gy daily fractions that includes the enhancing area.

Question 3

In adult patients (aged 65 and under) with newly diagnosed glioblastoma, is a tailored target volume superior to regional RT for reduction of radiation-induced toxicity while maintaining efficacy?

Recommendation

Level II: It is recommended that radiation therapy planning include 1–2 cm margin around the radiographically T1 weighted contrast-enhancing tumor volume or the T2 weighted abnormality on MRI.

Level III: Recalculation of the radiation volume during RT treatment may be necessary to reduce the radiated volume of normal brain since the volume of surgical defect will change during the long period of RT.

Question 4

In adult patients (aged 65 and under) with newly diagnosed glioblastoma, does the addition of RT of the subventricular zone to standard tumor volume treatment improve tumor control and overall survival?

Recommendation

No recommendation can be formulated as there is contradictory evidence in favor of and against intentional radiation of the subventricular zone (SVZ)

Question 5

In elderly (age > 65 years) and/or frail patients with newly diagnosed glioblastoma, does the addition of RT to surgical intervention improve disease control and overall survival?

Recommendation

Level I: Radiation therapy is recommended for treatment of elderly and frail patients with newly diagnosed glioblastoma to improve overall survival.

Question 6

In elderly (age > 65 years) and/or frail patients with newly diagnosed glioblastoma, does modification of RT dose and fractionation scheme from standard regimens decrease toxicity and improve disease control and survival?

Recommendation

Level II: Short RT treatment schemes are recommended in frail and elderly patients as compared to conventional 60 Gy given in 2 daily fractions because overall survival is not different while RT risk profile is better for the short RT scheme.

Level II: The 40.05 Gy dose given in 15 fractions or 25 Gy dose given in 5 fractions or 34 Gy dose given in 10 fractions should be considered as appropriate doses for Short RT treatments in elderly and/or frail patients.

Question 7

In adult patients with newly diagnosed glioblastoma is there advantage to delaying the initiation of RT instead of starting it 2 weeks after surgical intervention in decreasing radiation-induced toxicity and improving disease control and survival?

Recommendation

Level III: It is suggested that RT for patients with newly diagnosed GBM starts within 6 weeks of surgical intervention as compared to later times. There is insufficient evidence to recommend the optimal specific post-operative day within the 6 weeks interval to start RT for adult patients with newly diagnosed glioblastoma that have undergone surgical resection.

Question 8

In adult patients with newly diagnosed supratentorial glioblastoma is Image-Modulated RT (IMRT) or similar techniques as effective as standard regional RT in providing tumor control and improve survival?

Recommendation

Level III: There is no evidence that IMRT is a better RT delivering modality when compared to conventional RT in improving overall survival in adult patients with newly diagnosed glioblastoma. Hence, IMRT should not be preferred over the Conventional RT delivery modality.

Question 9

In adult patients with newly diagnosed glioblastoma does the use of radiosensitizers with RT improve the efficacy of RT as determined by disease control and overall survival?

Recommendation

Level III: Iododeoxyuridine is not recommended to be used as radiosensitizer during RT treatment for patients with newly diagnosed GBM

Question 10

In adult patients with newly diagnosed glioblastoma is the use of Ultrafractionated RT superior to standard fractionation regimens in improving disease control and survival?

Recommendation

There is insufficient evidence to formulate a recommendation regarding the use of ultrafractionated RT schemes and patient population that could benefit from it.

Question 11

In patients with poor prognosis with newly diagnosed glioblastoma is hypofractionated RT indicated instead of a standard fractionation regimen as measured by extent of toxicity, disease control and survival?

Recommendation

Level I: Hypofractionated RT schemes may be used for patients with poor prognosis and limited survival without compromising response. There is insufficient evidence in the literature for us to be able to recommend the optimal hypofractionated RT scheme that will confer longest overall survival and/or confer the same overall survival with less toxicities and shorter treatment time.

Question 12

In adult patients with newly diagnosed glioblastoma is the addition of brachytherapy to standard fractionated RT indicated to improve disease control and survival?

Recommendation

Level I: Brachytherapy as a boost to external beam RT has not been shown to be beneficial and is not recommended in the routine management of patients with newly diagnosed GBM.

Question 13

In elderly patients (> 65 year old) with newly diagnosed glioblastoma under what circumstances is accelerated hyperfractionated RT indicated instead of a standard fractionation regimen as measured by extent of toxicity, disease control and survival?

Recommendation

Level III: Accelerated Hyperfractionated RT with a total RT dose of 45 Gy or 48 Gy has been shown to shorten the treatment time without detriment in survival when compared to conventional external beam RT and should be considered as an option for treatment of elderly patients with newly diagnosed GBM.

Question 14

In adult patients with newly diagnosed glioblastoma is the addition of Stereotactic Radiosurgery (SRS) boost to conventional standard fractionated RT indicated to improve disease control and survival?

Recommendation

Level I: Stereotactic Radiosurgery boost to external beam RT has not been shown to be beneficial and is not recommended in patients undergoing routine management of newly diagnosed malignant glioma.

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Data Availability

All data are available by request.

Abbreviations

AHRT:

Hypofractionated accelerated RT

ART:

Accelerated radiation therapy

Bx:

Biopsy

CD:

Complete response

CFRT:

Conventional fractionated radiation therapy

CGE:

Cobalt grey equivalent

CTV:

Clinical tumor volume

EBRT:

External beam radiation therapy

FRT:

Fractionated radiation therapy

FSRT:

Fractionated stereotactic RT

GBM:

Glioblastoma multiforme

GTR:

Gross total resection

GTV:

Gross tumor volume

IMRT:

Intensity modulated radiation therapy

MST:

Median survival time

NTR:

Near total resection

OS:

Overall survival

PD:

Progressive disease

PR:

Partial response

PFS:

Progression free survival

PTV:

Planning target volume

RT:

Radiation therapy

SD:

Stable disease

SRT:

Stereotactic radiation therapy

STR:

Subtotal resection

SVZ:

Subventricular zone

TM:

Tumor mass

TMZ:

Temozolomide

TTP:

Time to progression

WBRT:

Whole brain radiation therapy

References

  1. Badiyan SN, Markovina S, Simpson JR et al (2014) Radiation therapy dose escalation for glioblastoma multiforme in the era of temozolomide. Int J Radiat Oncol Biol Phys 90:877–885. https://doi.org/10.1016/j.ijrobp.2014.07.014

    Article  PubMed  Google Scholar 

  2. Buatti J, Ryken TC, Smith MC et al (2008) Radiation therapy of pathologically confirmed newly diagnosed glioblastoma in adults. J Neurooncol 89:313–337. https://doi.org/10.1007/s11060-008-9617-2

    Article  PubMed  Google Scholar 

  3. Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996. https://doi.org/10.1056/NEJMoa043330

    Article  CAS  Google Scholar 

  4. Rusthoven CG, Carlson JA, Waxweiler TV et al (2014) The impact of adjuvant radiation therapy for high-grade gliomas by histology in the United States population. Int J Radiat Oncol Biol Phys 90:894–902. https://doi.org/10.1016/j.ijrobp.2014.07.046

    Article  PubMed  Google Scholar 

  5. Tsien CI, Brown D, Normolle D et al (2012) Concurrent temozolomide and dose-escalated intensity-modulated radiation therapy in newly diagnosed glioblastoma. Clin Cancer Res 18:273–279. https://doi.org/10.1158/1078-0432.CCR-11-2073

    Article  CAS  PubMed  Google Scholar 

  6. McDonald MW, Shu H-KG, Curran WJ, Crocker IR (2011) Pattern of failure after limited margin radiotherapy and temozolomide for glioblastoma. Int J Radiat Oncol Biol Phys 79:130–136. https://doi.org/10.1016/j.ijrobp.2009.10.048

    Article  CAS  PubMed  Google Scholar 

  7. Kim TG, Lim DH (2013) Interfractional variation of radiation target and adaptive radiotherapy for totally resected glioblastoma. J Korean Med Sci 28:1233–1237. https://doi.org/10.3346/jkms.2013.28.8.1233

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lee P, Eppinga W, Lagerwaard F et al (2013) Evaluation of high ipsilateral subventricular zone radiation therapy dose in glioblastoma: a pooled analysis. Int J Radiat Oncol Biol Phys 86:609–615. https://doi.org/10.1016/j.ijrobp.2013.01.009

    Article  PubMed  Google Scholar 

  9. Elicin O, Inac E, Uzel EK et al (2014) Relationship between survival and increased radiation dose to subventricular zone in glioblastoma is controversial. J Neurooncol 118:413–419. https://doi.org/10.1007/s11060-014-1424-3

    Article  CAS  PubMed  Google Scholar 

  10. Chen L, Guerrero-Cazares H, Ye X et al (2013) Increased subventricular zone radiation dose correlates with survival in glioblastoma patients after gross total resection. Int J Radiat Oncol Biol Phys 86:616–622. https://doi.org/10.1016/j.ijrobp.2013.02.014

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gupta T, Nair V, Paul SN et al (2012) Can irradiation of potential cancer stem-cell niche in the subventricular zone influence survival in patients with newly diagnosed glioblastoma? J Neurooncol 109:195–203. https://doi.org/10.1007/s11060-012-0887-3

    Article  PubMed  Google Scholar 

  12. Foro Arnalot P, Pera O, Rodriguez N et al (2017) Influence of incidental radiation dose in the subventricular zone on survival in patients with glioblastoma multiforme treated with surgery, radiotherapy, and temozolomide. Clin Transl Oncol 19:1225–1231. https://doi.org/10.1007/s12094-017-1659-5

    Article  CAS  PubMed  Google Scholar 

  13. Keime-Guibert F, Chinot O, Taillandier L (2007) Radiotherapy for glioblastoma in the elderly. N Engl J Med 356:1527–1535. https://doi.org/10.7812/TPP/14-083

    Article  CAS  PubMed  Google Scholar 

  14. Babu R, Komisarow JM, Agarwal VJ et al (2016) Glioblastoma in the elderly: the effect of aggressive and modern therapies on survival. J Neurosurg 124:998–1007. https://doi.org/10.3171/2015.4.JNS142200

    Article  CAS  PubMed  Google Scholar 

  15. Abdullah KG, Ramayya A, Thawani JP et al (2015) Factors associated with increased survival after surgical resection of glioblastoma in octogenarians. PLoS ONE 10:e0127202. https://doi.org/10.1371/journal.pone.0127202

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Niyazi M, Schwarz SB, Suchorska B, Belka C (2012) Radiotherapy with and without temozolomide in elderly patients with glioblastoma. Strahlenther Onkol 188:154–159. https://doi.org/10.1007/s00066-011-0026-7

    Article  CAS  PubMed  Google Scholar 

  17. Scott J, Tsai Y-Y, Chinnaiyan P, Yu H-HM (2011) Effectiveness of radiotherapy for elderly patients with glioblastoma. Int J Radiat Oncol Biol Phys 81:206–210. https://doi.org/10.1016/j.ijrobp.2010.04.033

    Article  PubMed  Google Scholar 

  18. Marijnen CAM, van den Berg SMP, van Duinen SG et al (2005) Radiotherapy is effective in patients with glioblastoma multiforme with a limited prognosis and in patients above 70 years of age: a retrospective single institution analysis. Radiother Oncol 75:210–216. https://doi.org/10.1016/j.radonc.2005.03.004

    Article  PubMed  Google Scholar 

  19. Combs SE, Wagner J, Bischof M et al (2008) Postoperative treatment of primary glioblastoma multiforme with radiation and concomitant temozolomide in elderly patients. Intl J Radiat Oncol Biol Phys 70:987–992. https://doi.org/10.1016/j.ijrobp.2007.07.2368

    Article  Google Scholar 

  20. Roa W, Kepka L, Kumar N, Sinaika V (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 33:4145–4150. https://doi.org/10.1200/JCO.2015.62.6606

    Article  PubMed  Google Scholar 

  21. Malmström A, Grønberg BH, Marosi C 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 13:916–926. https://doi.org/10.1016/S1470-2045(12)70265-6

    Article  CAS  PubMed  Google Scholar 

  22. Minniti G, Scaringi C, Baldoni A et al (2013) Health-related quality of life in elderly patients with newly diagnosed glioblastoma treated with short-course radiation therapy plus concomitant and adjuvant temozolomide. Int J Radiat Oncol Biol Phys 86:285–291. https://doi.org/10.1016/j.ijrobp.2013.02.013

    Article  PubMed  Google Scholar 

  23. Minniti G, Scaringi C, Lanzetta G et al (2015) Standard (60 Gy) or short-course (40 Gy) irradiation plus concomitant and adjuvant temozolomide for elderly patients with glioblastoma: a propensity-matched analysis. Int J Radiat Oncol Biol Phys 91:109–115. https://doi.org/10.1016/j.ijrobp.2014.09.013

    Article  CAS  PubMed  Google Scholar 

  24. Biau J, Chautard E, De Schlichting E et al (2017) Radiotherapy plus temozolomide in elderly patients with glioblastoma: a “real-life” report. Radiat Oncol 12:197. https://doi.org/10.1186/s13014-017-0929-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Bracci S, Laigle-Donadey F, Hitchcock K et al (2016) Role of irradiation for patients over 80 years old with glioblastoma: a retrospective cohort study. J Neurooncol 129:347–353. https://doi.org/10.1007/s11060-016-2182-1

    Article  CAS  PubMed  Google Scholar 

  26. Wang TJC, Wu C-C, Jani A et al (2016) Hypofractionated radiation therapy versus standard fractionated radiation therapy with concurrent temozolomide in elderly patients with newly diagnosed glioblastoma. Pract Radiat Oncol 6:306–314. https://doi.org/10.1016/j.prro.2015.12.001

    Article  PubMed  Google Scholar 

  27. Fariselli L, Pinzi V, Milanesi I et al (2013) Short-course radiotherapy in elderly patients with glioblsastoma: feasibility and efficacy of results from a single centre. Strahlenther Onkol 189:456–461. https://doi.org/10.1007/s00066-013-0346-x

    Article  CAS  PubMed  Google Scholar 

  28. Minniti G, Lanzetta G, Scaringi C et al (2012) Phase II study of short-course radiotherapy plus concomitant and adjuvant temozolomide in elderly patients with glioblastoma. Int J Radiat Oncol Biol Phys 83:93–99. https://doi.org/10.1016/j.ijrobp.2011.06.1992

    Article  CAS  PubMed  Google Scholar 

  29. Idbaih A, Taillibert S, Simon JM et al (2008) Short course of radiation therapy in elderly patients with glioblastoma multiforme. Cancer Radiother 12:788–792. https://doi.org/10.1016/j.canrad.2008.05.007

    Article  CAS  PubMed  Google Scholar 

  30. Guedes de Castro D, Matiello J, Roa W et al (2017) Survival outcomes with short-course radiation therapy in elderly patients with glioblastoma: data from a randomized phase 3 trial. Int J Radiat Oncol Biol Phys 98:931–938. https://doi.org/10.1016/j.ijrobp.2017.03.037

    Article  PubMed  Google Scholar 

  31. Mak KS, Agarwal A, Qureshi MM, Truong MT (2017) Hypofractionated short-course radiotherapy in elderly patients with glioblastoma multiforme: an analysis of the National Cancer Database. Cancer Med 6:1192–1200. https://doi.org/10.1002/cam4.1070

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Adeberg S, Bostel T, Harrabi S et al (2015) Impact of delays in initiating postoperative chemoradiation while determining the MGMT promoter-methylation statuses of patients with primary glioblastoma. BMC Cancer 15:558. https://doi.org/10.1186/s12885-015-1545-x

    Article  PubMed  PubMed Central  Google Scholar 

  33. Han SJ, Rutledge WC, Molinaro AM et al (2015) The effect of timing of concurrent chemoradiation in patients with newly diagnosed glioblastoma. Neurosurgery 77:248–253. https://doi.org/10.1227/NEU.0000000000000766

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sun MZ, Oh T, Ivan ME et al (2015) Survival impact of time to initiation of chemoradiotherapy after resection of newly diagnosed glioblastoma. J Neurosurg 122:1144–1150. https://doi.org/10.3171/2014.9.JNS14193

    Article  PubMed  Google Scholar 

  35. Spratt DE, Folkert M, Zumsteg ZS et al (2014) Temporal relationship of post-operative radiotherapy with temozolomide and oncologic outcome for glioblastoma. J Neurooncol 116:357–363. https://doi.org/10.1007/s11060-013-1302-4

    Article  CAS  PubMed  Google Scholar 

  36. Valduvieco I, Verger E, Bruna J et al (2013) Impact of radiotherapy delay on survival in glioblastoma. Clin Transl Oncol 15:278–282. https://doi.org/10.1007/s12094-012-0916-x

    Article  PubMed  Google Scholar 

  37. Lai R, Hershman DL, Doan T, Neugut AI (2010) The timing of cranial radiation in elderly patients with newly diagnosed glioblastoma multiforme. Neuro-oncology 12:190–198. https://doi.org/10.1093/neuonc/nop004

    Article  PubMed  PubMed Central  Google Scholar 

  38. Randolph DM, McTyre ER, Paulsson AK et al (2016) Impact of timing of radiotherapy in patients with newly diagnosed glioblastoma. Clin Neurol Neurosurg 151:73–78. https://doi.org/10.1016/j.clineuro.2016.10.012

    Article  PubMed  Google Scholar 

  39. Wang TJC, Jani A, Estrada JP et al (2016) Timing of adjuvant radiotherapy in glioblastoma patients: a single-institution experience with more than 400 patients. Neurosurgery 78:676–682. https://doi.org/10.1227/NEU.0000000000001036

    Article  PubMed  Google Scholar 

  40. Noel G, Huchet A, Feuvret L et al (2012) Waiting times before initiation of radiotherapy might not affect outcomes for patients with glioblastoma: a French retrospective analysis of patients treated in the era of concomitant temozolomide and radiotherapy. J Neurooncol 109:167–175. https://doi.org/10.1007/s11060-012-0883-7

    Article  PubMed  Google Scholar 

  41. Blumenthal DT, Won M, Mehta MP et al (2009) Short delay in initiation of radiotherapy may not affect outcome of patients with glioblastoma: a secondary analysis from the radiation therapy oncology group database. J Clin Oncol 27:733–739. https://doi.org/10.1200/JCO.2008.18.9035

    Article  PubMed  Google Scholar 

  42. Chen Y-D, Feng J, Fang T et al (2013) Effect of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy on clinical outcomes in patients with glioblastoma multiforme. Chin Med J 126:2320–2324. https://doi.org/10.3760/cma.j.issn.0366-6999.20130218

    Article  PubMed  Google Scholar 

  43. Goffman TE, Dachowski LJ, Bobo H et al (1992) Long-term follow-up on National Cancer Institute Phase I/II study of glioblastoma multiforme treated with iododeoxyuridine and hyperfractionated irradiation. J Clin Oncol 10:264–268

    CAS  PubMed  Google Scholar 

  44. Beauchesne P, Bernier V, Carnin C et al (2010) Prolonged survival for patients with newly diagnosed, inoperable glioblastoma with 3-times daily ultrafractionated radiation therapy. Neuro-oncology 12:595–602. https://doi.org/10.1093/neuonc/noq008

    Article  PubMed  PubMed Central  Google Scholar 

  45. Beauchesne P, Quillien V, Faure G et al (2016) A concurrent ultra-fractionated radiation therapy and temozolomide treatment: a promising therapy for newly diagnosed, inoperable glioblastoma. Int J Cancer 138:1538–1544. https://doi.org/10.1002/ijc.29898

    Article  CAS  PubMed  Google Scholar 

  46. Navarria P, Pessina F, Franzese C et al (2018) Hypofractionated radiation therapy (HFRT) versus conventional fractionated radiation therapy (CRT) for newly diagnosed glioblastoma patients. A propensity score matched analysis. Radiother Oncol 127:108–113. https://doi.org/10.1016/j.radonc.2017.12.006

    Article  PubMed  Google Scholar 

  47. Azoulay M, Santos F, Souhami L et al (2015) Comparison of radiation regimens in the treatment of Glioblastoma multiforme: results from a single institution. Radiat Oncol 10:106. https://doi.org/10.1186/s13014-015-0396-6

    Article  PubMed  PubMed Central  Google Scholar 

  48. Arvold ND, Tanguturi SK, Aizer AA et al (2015) Hypofractionated versus standard radiation therapy with or without temozolomide for older glioblastoma patients. Int J Radiat Oncol Biol Phys 92:384–389. https://doi.org/10.1016/j.ijrobp.2015.01.017

    Article  CAS  PubMed  Google Scholar 

  49. Lim YJ, Kim IH, Han TJ et al (2015) Hypofractionated chemoradiotherapy with temozolomide as a treatment option for glioblastoma patients with poor prognostic features. Int J Clin Oncol 20:21–28. https://doi.org/10.1007/s10147-014-0690-6

    Article  CAS  PubMed  Google Scholar 

  50. Iuchi T, Hatano K, Kodama T et al (2014) Phase 2 trial of hypofractionated high-dose intensity modulated radiation therapy with concurrent and adjuvant temozolomide for newly diagnosed glioblastoma. Int J Radiat Oncol Biol Phys 88:793–800. https://doi.org/10.1016/j.ijrobp.2013.12.011

    Article  CAS  PubMed  Google Scholar 

  51. Ciammella P, Galeandro M, D’Abbiero N et al (2013) Hypo-fractionated IMRT for patients with newly diagnosed glioblastoma multiforme: a 6 year single institutional experience. Clin Neurol Neurosurg 115:1609–1614. https://doi.org/10.1016/j.clineuro.2013.02.001

    Article  PubMed  Google Scholar 

  52. Reddy K, Damek D, Gaspar LE et al (2012) Phase II trial of hypofractionated IMRT with temozolomide for patients with newly diagnosed glioblastoma multiforme. Int J Radiat Oncol Biol Phys 84:655–660. https://doi.org/10.1016/j.ijrobp.2012.01.035

    Article  CAS  PubMed  Google Scholar 

  53. Terasaki M, Eto T, Nakashima S et al (2011) A pilot study of hypofractionated radiation therapy with temozolomide for adults with glioblastoma multiforme. J Neurooncol 102:247–253. https://doi.org/10.1007/s11060-010-0306-6

    Article  CAS  PubMed  Google Scholar 

  54. Roa W (2004) Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol 22:1583–1588. https://doi.org/10.1200/JCO.2004.06.082

    Article  CAS  PubMed  Google Scholar 

  55. Waters JD, Rose B, Gonda DD et al (2013) Immediate post-operative brachytherapy prior to irradiation and temozolomide for newly diagnosed glioblastoma. J Neurooncol 113:467–477. https://doi.org/10.1007/s11060-013-1139-x

    Article  CAS  PubMed  Google Scholar 

  56. Matsuda M, Yamamoto T, Ishikawa E et al (2011) Prognostic factors in glioblastoma multiforme patients receiving high-dose particle radiotherapy or conventional radiotherapy. Br J Radiol 84:54–60. https://doi.org/10.1259/bjr/29022270

    Article  Google Scholar 

  57. Fariselli L, Cuppini L, Gaviani P et al (2017) Short course radiotherapy concomitant with temozolomide in GBM patients: a phase II study. Tumori 103:457–463. https://doi.org/10.5301/tj.5000672

    Article  PubMed  Google Scholar 

  58. Buckner JC, Ballman KV, Michalak JC et al (2006) Phase III trial of carmustine and cisplatin compared with carmustine alone and standard radiation therapy or accelerated radiation therapy in patients with glioblastoma multiforme: North Central Cancer Treatment Group 93–72-52 and Southwest Oncology Group 9503 Trials. J Clin Oncol 24:3871–3879. https://doi.org/10.1200/JCO.2005.04.6979

    Article  CAS  PubMed  Google Scholar 

  59. Einstein DB, Wessels B, Bangert B et al (2012) Phase II trial of radiosurgery to magnetic resonance spectroscopy-defined high-risk tumor volumes in patients with glioblastoma multiforme. Int J Radiat Oncol Biol Phys 84:668–674. https://doi.org/10.1016/j.ijrobp.2012.01.020

    Article  PubMed  PubMed Central  Google Scholar 

  60. Kong DS, Nam D-H, Lee J-I et al (2006) Preservation of quality of life by preradiotherapy stereotactic radiosurgery for unresectable glioblastoma multiforme. J Neurosurg 105(Suppl):139–143. https://doi.org/10.3171/sup.2006.105.7.139

    Article  PubMed  Google Scholar 

  61. Cardinale R, Won M, Choucair A et al (2006) A phase II trial of accelerated radiotherapy using weekly stereotactic conformal boost for supratentorial glioblastoma multiforme: RTOG 0023. Intl J Radiat Oncol Biol Phys 65:1422–1428. https://doi.org/10.1016/j.ijrobp.2006.02.042

    Article  Google Scholar 

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Acknowledgements

We acknowledge the following individual peer reviewers of the Joint Guidelines Review Committee for their contributions to the development process: John O’Toole, MD, David Bauer, MD, Kimon Bekelis, MD, Andrew Carlson, MD, Isabelle Germano, MD, Catherine McClung Smith, MD, and Jonathan Sherman, MD

Disclaimer of liability

This clinical systematic review and evidence-based guideline was developed by a multidisciplinary physician volunteer task force and serves as an educational tool designed to provide an accurate review of the subject matter covered. These guidelines are disseminated with the understanding that the recommendations by the authors and consultants who have collaborated in their development are not meant to replace the individualized care and treatment advice from a patient's physician(s). If medical advice or assistance is required, the services of a competent physician should be sought. The proposals contained in these guidelines may not be suitable for use in all circumstances. The choice to implement any particular recommendation contained in these guidelines must be made by a managing physician in light of the situation in each particular patient and on the basis of existing resources.

Funding

Sponsored by: Congress of Neurological Surgeons Joint Section on Tumors. These guidelines were funded exclusively by the CNS Guidelines Committee and the AANS/CNS Joint Tumor Section Executive Committee with no funding from any outside commercial sources to support the development of this document.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Inova Neuroscience and Spine Institute, 3300 Gallows Rd, NPT 2nd Floor, Suite 200, Falls Church, VA, USA

    Mateo Ziu

  2. Department of Neurosurgery, The UT at MD Anderson Cancer Center, Houston, TX, USA

    Betty Y. S. Kim

  3. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Wen Jiang

  4. Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Timothy Ryken

  5. Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA

    Jeffrey J. Olson

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  1. Mateo Ziu
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Corresponding author

Correspondence to Mateo Ziu.

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Conflict of interest

Mateo Ziu: None; Betty Y Kim: None; Wen Jiang: None; Timothy C. Ryken: None; Jeffrey J. Olson: American Cancer Society, Editorial Consultant. The Update on Newly Diagnosed Glioblastoma Task Force members were required to report all possible COIs prior to beginning work on the guideline, using the COI disclosure form of the AANS/CNS Joint Guidelines Committee, including potential COIs that are unrelated to the topic of the guideline. The CNS Guidelines Committee and Guideline Task Force Chair reviewed the disclosures and either approved or disapproved the nomination. The CNS Guidelines Committee and Guideline Task Force Chair are given latitude to approve nominations of Task Force Members with possible conflicts and address this by restricting the writing and reviewing privileges of that person to topics unrelated to the possible COIs.

Disclosures

These guidelines were funded exclusively by the CNS Guidelines Committee and the AANS/CNS Joint Tumor Section Executive Committee with no funding from any outside commercial sources to support the development of this document.

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Ziu, M., Kim, B.Y.S., Jiang, W. et al. The role of radiation therapy in treatment of adults with newly diagnosed glioblastoma multiforme: a systematic review and evidence-based clinical practice guideline update. J Neurooncol 150, 215–267 (2020). https://doi.org/10.1007/s11060-020-03612-7

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