Radiation therapy for glioblastoma: Executive summary of an American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline
Radiation therapy for glioblastoma: Executive summary of an American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline
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DOI：
10.1016/j.prro.2016.03.007
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发表时间：
2016-07-01
影响因子：
3.3
通讯作者：
Chang, Eric
中科院分区：
文献类型：
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作者：
Cabrera, Alvin R.;Kirkpatrick, John P.;Chang, Eric
目的：目前的循证指南放射治疗胶质母细胞瘤不产生从brainstem.Methods和材料：美国放射肿瘤学会（ASTRO）召开胶质母细胞瘤指南小组进行系统的文献回顾调查以下内容：（1）放射治疗后，活检/切除胶质母细胞瘤和如何全身治疗修改其效果？(2)胶质母细胞瘤活检/切除术后外照射放射治疗的最佳剂量分割方案是什么？根据治疗前特征（如年龄或体能状态），治疗可能会有哪些变化？(3)胶质母细胞瘤治疗性外照射放射治疗的理想靶体积是多少？(4)在完成标准一线治疗后复发的胶质母细胞瘤患者中，再放疗的作用是什么？使用预先定义的共识建立方法支持ASTRO批准的工具分级证据质量和建议strength.Results：活检或切除术后，胶质母细胞瘤患者合理的性能状态高达70岁，应接受常规分割放射治疗（例如，60戈伊在2-戈伊分数）与并发和辅助替莫唑胺。不建议在此方案中常规添加贝伐珠单抗。体力状况合理的老年患者（≥ 70岁）应接受大分割放射治疗（例如，40戈伊，2.66-戈伊分割）;初步证据可能支持在该方案中添加替莫唑胺作为同步和辅助治疗。部分脑照射是放射递送的标准范例。对于靶体积定义，存在多种可接受的策略，通常涉及2个阶段（主要体积和增强体积）或1个阶段（单个体积）。对于复发性胶质母细胞瘤，局灶性再照射可以考虑在年轻患者具有良好的性能status.Conclusions：放射治疗在治疗胶质母细胞瘤中占有不可或缺的作用。是否以及如何应用放射治疗取决于肿瘤和患者的特定特征，包括年龄和性能状态。(C)2016年美国放射肿瘤学会。爱思唯尔公司出版All rights reserved.
Purpose: To present evidence-based guidelines for radiation therapy in treating glioblastoma not arising from the brainstem.Methods and materials: The American Society for Radiation Oncology (ASTRO) convened the Glioblastoma Guideline Panel to perform a systematic literature review investigating the following: (1) Is radiation therapy indicated after biopsy/resection of glioblastoma and how does systemic therapy modify its effects? (2) What is the optimal dose-fractionation schedule for external beam radiation therapy after biopsy/resection of glioblastoma and how might treatment vary based on pretreatment characteristics such as age or performance status? (3) What are ideal target volumes for curative-intent external beam radiation therapy of glioblastoma? (4) What is the role of reirradiation among glioblastoma patients whose disease recurs following completion of standard first-line therapy? Guideline recommendations were created using predefined consensus-building methodology supported by ASTRO-approved tools for grading evidence quality and recommendation strength.Results: Following biopsy or resection, glioblastoma patients with reasonable performance status up to 70 years of age should receive conventionally fractionated radiation therapy (eg, 60 Gy in 2-Gy fractions) with concurrent and adjuvant temozolomide. Routine addition of bevacizumab to this regimen is not recommended. Elderly patients (>= 70 years of age) with reasonable performance status should receive hypofractionated radiation therapy (eg, 40 Gy in 2.66-Gy fractions); preliminary evidence may support adding concurrent and adjuvant temozolomide to this regimen. Partial brain irradiation is the standard paradigm for radiation delivery. A variety of acceptable strategies exist for target volume definition, generally involving 2 phases (primary and boost volumes) or 1 phase (single volume). For recurrent glioblastoma, focal reirradiation can be considered in younger patients with good performance status.Conclusions: Radiation therapy occupies an integral role in treating glioblastoma. Whether and how radiation therapy should be applied depends on characteristics specific to tumor and patient, including age and performance status. (C) 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.