Fractionated Stereotactic Radiosurgery + Taxol
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Abtract of Annual meeting of the American Society Of Clinical Oncologists (1998)

IMPROVING SURVIVAL FOR RECURRENT GLIOBLASTOMA MULTIFORME (RGM) WITH FRACTIONATED STEREOTACTIC RADIOSURGERY (FSR) AND CONCURRENT TAXOL.

G. Lederman, M. Odaimi, M. Fine, S. Wertheim, J. Lowry, M. Wrzolek, H. Rashid, G. Qian, E. Lombardi, E. Arbit. University Hospital, Staten Island, NY.

Standard therapy for RGM is associated with rapid tumor growth, neurological deterioration and high toxicity. Radiosurgery combined with a radiosensitizer, Taxol offers the appeal of fractionated therapy using a non-invasive head frame. FSR/T was compared to single fraction radiosurgery (SFR) for RGM. 69 patients (pts) with RGM received 4 weekly fractions FSR/T. Tumor volume was 1.5 to 150.3cc (mean 46.5). FSR dose was 450--900 cGy (mean 609.4). Taxol was administered in escalating doses from 80--160mg/m2. Karnofsky Performance Status (KPS) ranged 50--100 (mean 70).

Retrospective analysis of 18 pts treated with SFR had tumor volume 4.1--127cc (mean 29.4) and dose 900--2500 cGy (mean 1816.7). KPS was 50--100 (mean 74). Of 34 pts evaluated with tumor volume 30cc, 25 received FSR/T. Tumor volume 1.5--29.0 (mean 14.8) receiving 450--900 cGy (mean 610.0) weekly times 4; KPS 50--90 (mean 71). Compared to 9 pts receiving SFR with tumor volume of 4.1--21.9cc (mean 11.2), receiving 900--2500 cGy (mean 1922.2); KPS 50--100 (mean 68). For the entire FSR/T group, the survival was 39% at 24 months (mos) (median survival 11 mos) compared to 6% at 24 mos (median survival 5.5 mos) in the SFR group (P < 0.05).

Analysis revealed improved survival for RGM pts with tumor volume of 30cc receiving FSR/T of 52% at 24 mos compared to 11% at 24 mos (P < 0.05).

This data suggests that FSR with concurrent Taxol is superior to single fraction radiosurgery and should encourage treatment approaches using FSR and radiation sensitizers to further enhance treatment.





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