title: [Interstitial boost and altered fractionation as novel approaches to dose escalation in the radiotherapy of glioblastoma multiforme].
abstract: BACKGROUND
  The practice of image-based three dimensional treatment planning and conformal radiotherapy techniques give the opportunity to elaborate optimal treatment forms for primary brain tumours.
  
  
  OBJECTIVE
  The authors examined the effect of two novel dose escalation methods on glioblastoma patients.
  
  
  METHODS
  In nine cases they treated T1 tumours with single HDR-AL boost of 10-12 Gy dose following the conventional fractionated 60 Gy external beam radiotherapy. In fifteen patients with T2-4 tumours an intensified, hypofractionated regimen with 2.25-2.5 Gy daily and 60 Gy total dose was applied. All the treatments were carried out with image-based conformal methods.
  
  
  RESULTS
  Majority of patients endured treatments without neurological deterioration. Transient neurotoxiticy was noticed in one and two cases, respectively. The median survival times (MST) were found to be 17 months (range: 9-25) and 12 months (range: 6-38) in the two groups, respectively. With respect to all patients, the MST was 13 months, while this value in the conventional treatment is generally considered to be 9-10 months. All the three patients who survived more than 18 months was treated with temozolamide chemotherapy as well.
  
  
  CONCLUSIONS
  Based on own experience and current knowledge of authors, it seems reasonable to apply higher biological dose focal radiotherapy and chemotherapy in case of glioblastoma patients with better prognosis. To define the optimal treatment regimens randomised clinical trials should be executed.
authors.affiliation: Országos Onkológiai Intézet, Sugárterápiás Osztály, Budapest. mangel@oncol.hu
authors.forename: László
authors.initials: L
authors.lastname: Mangel
authors.forename: Jenö
authors.initials: J
authors.lastname: Julow
authors.forename: Tibor
authors.initials: T
authors.lastname: Major
authors.forename: János
authors.initials: J
authors.lastname: Hável
authors.forename: József
authors.initials: J
authors.lastname: Lövey
authors.forename: Arpád
authors.initials: A
authors.lastname: Viola
authors.forename: András
authors.initials: A
authors.lastname: Somogyi
authors.forename: György
authors.initials: G
authors.lastname: Németh
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods; D019583:Dose Fractionation, Radiation; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome