title: Fractionated stereotactic radiotherapy boost after post-operative radiotherapy in patients with high-grade gliomas.
abstract: OBJECTIVE
  To determine the value and the toxicity of an additional fractionated stereotactic boost as used in the joint randomized EORTC-22972/MRC-BR10 study in patients with malignant gliomas.
  
  
  METHODS
  Seventeen patients (11 male, six female) with a high-grade glioma (two WHO III, 15 WHO IV) < or =4 cm in maximum diameter, with a good performance status (WHO > or =2), were treated with a fractionated stereotactic radiotherapy (SRT) boost to 20 Gy in four fractions following partial brain irradiation to a dose of 60 Gy in 30 fractions. This patient group was compared with historical data in a matched-pair analysis.
  
  
  RESULTS
  All patients were treated by conventional radiotherapy and a SRT boost (15 patients received 20 Gy and two patients 10 Gy). Acute side effects included fatigue (two), impairment of short-term memory (one) and worsening of pre-existing symptoms (one). No patient developed steroid dependence after SRT. One patient was re-operated for radiation necrosis. At a median follow-up of 25 months (9-50 months) 14 patients recurred locally. Survival was 77% at 1 year and 42% at 2 years; progression-free survival was 70% at 1 year and 35% at 2 years for all patients, respectively. Median survival for the whole patient group is 20 months. Comparison with a matched historical group showed a significantly better survival for the group treated with a stereotactic boost (P<0.0001).
  
  
  CONCLUSIONS
  A fractionated stereotactic boost after standard external beam radiotherapy in selected patients with high-grade glioma is feasible and well tolerated with low toxicity. Compared to historical data survival is significantly better with an additional SRT boost. However, its effectiveness has to be proven in a randomized trial.
authors.affiliation: Radiation-Oncology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Brigitta G
authors.initials: BG
authors.lastname: Baumert
authors.forename: Johannes
authors.initials: J
authors.lastname: Lutterbach
authors.forename: René
authors.initials: R
authors.lastname: Bernays
authors.forename: J Bernard
authors.initials: JB
authors.lastname: Davis
authors.forename: Frank L
authors.initials: FL
authors.lastname: Heppner
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D016371:Cranial Irradiation / Q000009:adverse effects* / Q000379:methods*; D019583:Dose Fractionation, Radiation; D005260:Female; D005909:Glioblastoma / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011182:Postoperative Care; D016032:Randomized Controlled Trials as Topic; D013238:Stereotaxic Techniques / Q000009:adverse effects; D016019:Survival Analysis