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Published byRachel Jasmin Lewis Modified over 9 years ago
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Principal Author, MD Second Author, MD PhD Third Author, MSc Institution, City, Country 23 January 2013
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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
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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
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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
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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
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