Positron emission tomography-guided conformai fast neutron therapy for glioblastoma multiforme

Keith J. Stelzer, James G. Douglas, David A. Mankoff, Daniel L. Silbergeld, Kenneth Krohn, George E. Laramore, Alexander M. Spence

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Glioblastoma multiforme (GBM) continues to be a difficult therapeutic challenge. Our study was conducted to determine whether improved survival and tumor control could be achieved with modern delivery of fast neutron radiation using three-dimensional treatment planning. Ten patients were enrolled. Eligibility criteria included pathologic diagnosis of GBM, age ≥18 years, and KPS ≥60. Patients underwent MRI and 18F-fluorodeoxyglucose PET (FDG PET) as part of initial three-dimensional treatment planning. Sequential targets were treated with noncoplanar fields to a total dose of 18 Gy in 16 fractions over 4 weeks. Median and 1-year overall survival were 55 weeks and 60%, respectively. One patient remains alive at last follow-up 255 weeks after diagnosis. Median progression-free survival was 16 weeks, and all patients had tumor progression by 39 weeks. Treatment was clinically well tolerated, but evidence of mild to moderate gliosis and microvascular sclerosis consistent with radiation injury was observed at autopsy in specimens taken from regions of contralateral brain that received approximately 6-10 Gy. Fast neutron radiation using modern imaging, treatment planning, and beam delivery was feasible to a total dose of 18 Gy, but tumor control probability was poor in comparison to that predicted from a dose-response model based on older studies. Steep dose-response curves for both tumor control and neurotoxicity continue to present a challenge to establishing a therapeutic window for fast neutron radiation in GBM, even with modern techniques.

Original languageEnglish (US)
Pages (from-to)88-92
Number of pages5
JournalNeuro-Oncology
Volume10
Issue number1
DOIs
StatePublished - Feb 2008
Externally publishedYes

Fingerprint

Fast Neutrons
Glioblastoma
Positron-Emission Tomography
Radiation
Neoplasms
Therapeutics
Radiation Injuries
Gliosis
Survival
Fluorodeoxyglucose F18
Sclerosis
Disease-Free Survival
Autopsy
Brain

Keywords

  • FDG PET
  • Glioblastoma multiforme
  • Neutron radiotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Clinical Neurology

Cite this

Stelzer, K. J., Douglas, J. G., Mankoff, D. A., Silbergeld, D. L., Krohn, K., Laramore, G. E., & Spence, A. M. (2008). Positron emission tomography-guided conformai fast neutron therapy for glioblastoma multiforme. Neuro-Oncology, 10(1), 88-92. https://doi.org/10.1215/15228517-2007-044

Positron emission tomography-guided conformai fast neutron therapy for glioblastoma multiforme. / Stelzer, Keith J.; Douglas, James G.; Mankoff, David A.; Silbergeld, Daniel L.; Krohn, Kenneth; Laramore, George E.; Spence, Alexander M.

In: Neuro-Oncology, Vol. 10, No. 1, 02.2008, p. 88-92.

Research output: Contribution to journalArticle

Stelzer, KJ, Douglas, JG, Mankoff, DA, Silbergeld, DL, Krohn, K, Laramore, GE & Spence, AM 2008, 'Positron emission tomography-guided conformai fast neutron therapy for glioblastoma multiforme', Neuro-Oncology, vol. 10, no. 1, pp. 88-92. https://doi.org/10.1215/15228517-2007-044
Stelzer, Keith J. ; Douglas, James G. ; Mankoff, David A. ; Silbergeld, Daniel L. ; Krohn, Kenneth ; Laramore, George E. ; Spence, Alexander M. / Positron emission tomography-guided conformai fast neutron therapy for glioblastoma multiforme. In: Neuro-Oncology. 2008 ; Vol. 10, No. 1. pp. 88-92.
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