Randomized comparison of stereotactic radiosurgery followed by conventional radiotherapy with carmustine to conventional radiotherapy with carmustine for patients with glioblastoma multiforme: report of Radiation Therapy Oncology Group 93-05 protocol.
OBJECTIVE
Conventional treatment of glioblastoma multiforme (GBM) cures less than 5% of patients. We investigated the effect of stereotactic radiosurgery (SRS) added to conventional external beam radiation therapy (EBRT) with carmustine (BCNU) on the survival of patients with GBM.


METHODS
A total of 203 patients with supratentorial GBM (tumor < or =40 mm) were randomly assigned either to postoperative SRS followed by EBRT (60 Gy) plus BCNU (80 mg/m(2) Days 1-3 every 8 weeks for six cycles) or to EBRT with BCNU alone. The dose of radiosurgery was tumor size-dependent and ranged from 15 Gy for largest to 24 Gy for smallest tumors. RT and BCNU were identical in both arms.


RESULTS
At a median follow-up time of 61 months, the median survival in the radiosurgery group was 13.5 months (95% confidence interval, 11.0-14.8) as compared with 13.6 months (95% confidence interval, 11.2-15.2, p = 0.5711) for the standard treatment group. There were also no significant differences in 2- and 3-year survival rates and in patterns of failure between the two arms. Quality of life deterioration and cognitive decline at the end of therapy, compared with baseline, were comparable and there was no difference in quality-adjusted survival between the arms.


CONCLUSIONS
Stereotactic radiosurgery followed by EBRT and BCNU does not improve the outcome in patients with GBM nor does it change the general quality of life or cognitive functioning.
Department of Oncology, Division of Radiation Oncology, McGill University, Montreal, Quebec, Canada. luis.souhami@muhc.mcgill.ca
Luis
L
Souhami
Wendy
W
Seiferheld
David
D
Brachman
Ervin B
EB
Podgorsak
Maria
M
Werner-Wasik
Robert
R
Lustig
Christopher J
CJ
Schultz
William
W
Sause
Paul
P
Okunieff
Jan
J
Buckner
Lucia
L
Zamorano
Minesh P
MP
Mehta
Walter J
WJ
Curran
D000293:Adolescent; D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D002330:Carmustine / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D016879:Salvage Therapy; D015173:Supratentorial Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016019:Survival Analysis; D017211:Treatment Failure
D018906:Antineoplastic Agents, Alkylating; D002330:Carmustine