Radiation Therapy for Glioblastoma: Executive Summary of an American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline

Publication date: Available online 31 March 2016
Source:Practical Radiation Oncology
Author(s): Alvin R. Cabrera, John Kirkpatrick, John Fiveash, Helen A. Shih, Eugene Koay, Stephen Lutz, Joshua Petit, Samuel Chao, Paul D. Brown, Michael Vogelbaum, David Reardon, Arnab Chakravarti, Patrick Y. Wen, Eric Chang, Caroline Patton
PurposeTo present evidence-based guidelines for radiotherapy in treating glioblastoma not arising from the brainstem.Methods and MaterialsThe American Society for Radiation Oncology 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 radiotherapy of glioblastoma?; (4) What is the role of re-irradiation 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.ResultsFollowing biopsy or resection, glioblastoma patients with reasonable performance status up to 70 years of age should receive conventionally fractionated radiotherapy (e.g., 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 old) with reasonable performance status should receive hypofractionated radiotherapy (e.g., 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 two phases (primary and boost volumes) or one phase (single volume). For recurrent glioblastoma, focal re-irradiation can be considered in younger patients with good performance status.ConclusionsRadiotherapy occupies an integral role in treating glioblastoma. Whether and how radiotherapy should be applied depends on characteristics specific to tumor and patient, including age and performance status.



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