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BioMed Research International
Volume 2014, Article ID 407026, 9 pages
http://dx.doi.org/10.1155/2014/407026
Clinical Study

Hypofractionated High-Dose Irradiation with Positron Emission Tomography Data for the Treatment of Glioblastoma Multiforme

1Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Gifu 505-0034, Japan
2Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, 630 Shimokobi, Kobi-cho, Minokamo, Gifu 505-0034, Japan
3Department of Radiation Oncology, Kizawa Memorial Hospital, Minokamo, Gifu 505-0034, Japan
4Department of Neurosurgery, Kizawa Memorial Hospital, Minokamo, Gifu 505-0034, Japan
5Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu 501-1193, Japan

Received 11 February 2014; Accepted 4 May 2014; Published 22 May 2014

Academic Editor: Yi-Xiang Wang

Copyright © 2014 Kazuhiro Miwa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This research paper presents clinical outcomes of hypofractionated high-dose irradiation by intensity-modulated radiation therapy (Hypo-IMRT) with 11C-methionine positron emission tomography (MET-PET) data for the treatment of glioblastoma multiforme (GBM). A total of 45 patients with GBM were treated with Hypo-IMRT after surgery. Gross tumor volume (GTV) was defined as the area of enhanced lesion on MRI, including MET-PET avid region; clinical target volume (CTV) was the area with 5 mm margin surrounding the GTV; planning target volume (PTV) was the area with 15 mm margin surrounding the CTV, including MET-PET moderate region. Hypo-IMRT was performed in 8 fractions; planning the dose for GTV was escalated to 68 Gy and that for CTV was escalated to 56 Gy, while keeping the dose delivered to the PTV at 40 Gy. Concomitant and adjuvant TMZ chemotherapy was administered. At a median follow-up of 18.7 months, median overall survival (OS) was 20.0 months, and median progression-free survival was 13.0 months. The 1- and 2-year OS rates were 71.2% and 26.3%, respectively. Adjuvant TMZ chemotherapy was significantly predictive of OS on multivariate analysis. Late toxicity included 7 cases of Grade 3-4 radiation necrosis. Hypo-IMRT with MET-PET data appeared to result in favorable survival outcomes for patients with GBM.