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Antoni D, Feuvret L, Biau J, Robert C, Mazeron JJ, Noël G. Radiation guidelines for gliomas. Cancer Radiother 2021; 26:116-128. [PMID: 34953698 DOI: 10.1016/j.canrad.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Gliomas are the most frequent primary brain tumour. The proximity of organs at risk, the infiltrating nature, and the radioresistance of gliomas have to be taken into account in the choice of prescribed dose and technique of radiotherapy. The management of glioma patients is based on clinical factors (age, KPS) and tumour characteristics (histology, molecular biology, tumour location), and strongly depends on available and associated treatments, such as surgery, radiation therapy, and chemotherapy. The knowledge of molecular biomarkers is currently essential, they are increasingly evolving as additional factors that facilitate diagnostics and therapeutic decision-making. We present the update of the recommendations of the French society for radiation oncology on the indications and the technical procedures for performing radiation therapy in patients with gliomas.
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Affiliation(s)
- D Antoni
- Service de radiothérapie, institut cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg cedex, France.
| | - L Feuvret
- Service de radiothérapie, CHU Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Biau
- Département universitaire de radiothérapie, centre Jean-Perrin, Unicancer, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 01, France
| | - C Robert
- Département de radiothérapie, institut de cancérologie Gustave-Roussy, 39, rue Camille-Desmoulin, 94800 Villejuif, France
| | - J-J Mazeron
- Service de radiothérapie, CHU Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - G Noël
- Service de radiothérapie, institut cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg cedex, France
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Apport du guidage par l’image pour le repositionnement au cours de la radiothérapie des tumeurs encéphaliques. Cancer Radiother 2018; 22:593-601. [DOI: 10.1016/j.canrad.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 11/20/2022]
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Khalifa J, Tensaouti F, Lusque A, Plas B, Lotterie JA, Benouaich-Amiel A, Uro-Coste E, Lubrano V, Cohen-Jonathan Moyal E. Subventricular zones: new key targets for glioblastoma treatment. Radiat Oncol 2017; 12:67. [PMID: 28424082 PMCID: PMC5397708 DOI: 10.1186/s13014-017-0791-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/24/2017] [Indexed: 12/19/2022] Open
Abstract
Background We aimed to identify subventricular zone (SVZ)-related prognostic factors of survival and patterns of recurrence among patients with glioblastoma. Methods Forty-three patients with primary diagnosed glioblastoma treated in our Cancer Center between 2006 and 2010 were identified. All patients received surgical resection, followed by temozolomide-based chemoradiation. Ipsilateral (iSVZ), contralateral (cSVZ) and bilateral (bSVZ) SVZs were retrospectively segmented and radiation dose-volume histograms were generated. Multivariate analysis using the Cox proportional hazards model was assessed to examine the relationship between prognostic factors and time to progression (TTP) or overall survival (OS). Results Median age was 59 years (range: 25–85). Median follow-up, OS and TTP were 22.7 months (range 7.5–69.7 months), 22.7 months (95% CI 14.5–26.2 months) and 6.4 months (95% CI 4.4–9.3 months), respectively. On univariate analysis, initial contact to SVZ was a poor prognostic factor for OS (18.7 vs 41.7 months, p = 0.014) and TTP (4.6 vs 12.9 months, p = 0.002). Patients whose bSVZ volume receiving at least 20 Gy (V20Gy) was greater than 84% had a significantly improved TTP (17.7 months vs 5.2 months, p = 0.017). This radiation dose coverage was compatible with an hippocampal sparing. On multivariate analysis, initial contact to SVZ and V20 Gy to bSVZ lesser than 84% remained poor prognostic factors for TTP (HR = 3.07, p = 0.012 and HR = 2.67, p = 0.047, respectively). Conclusion Our results suggest that contact to SVZ, as well as insufficient bSVZ radiation dose coverage (V20Gy <84%), might be independent poor prognostic factors for TTP. Therefore, targeting SVZ could be of crucial interest for optimizing glioblastoma treatment.
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Affiliation(s)
- J Khalifa
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse - Oncopôle/Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France.
| | - F Tensaouti
- Toulouse NeuroImaging Center, ToNIC, Université de Toulouse, INSERM, Université Paul Sabatier, Toulouse, France
| | - A Lusque
- Department of Biostatistics, Institut Universitaire du Cancer de Toulouse - Oncopôle/Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France
| | - B Plas
- Department of Neurosurgery, Institut Universitaire du Cancer de Toulouse - Purpan, Place du Docteur Baylac, Toulouse Cedex, 31059, France
| | - J-A Lotterie
- Toulouse NeuroImaging Center, ToNIC, Université de Toulouse, INSERM, Université Paul Sabatier, Toulouse, France.,Department of Nuclear Medicine, CHU Rangueil, 1 avenue du Pr Jean Poulhès TSA 50032, Toulouse Cedex, 31059, France
| | - A Benouaich-Amiel
- Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse - Oncopôle/Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France
| | - E Uro-Coste
- Department of Pathology, Institut Universitaire du Cancer de Toulouse - Oncopôle/Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France.,Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France.,INSERM U1037, Centre de Recherche contre le Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France
| | - V Lubrano
- Toulouse NeuroImaging Center, ToNIC, Université de Toulouse, INSERM, Université Paul Sabatier, Toulouse, France.,Department of Neurosurgery, Institut Universitaire du Cancer de Toulouse - Purpan, Place du Docteur Baylac, Toulouse Cedex, 31059, France
| | - E Cohen-Jonathan Moyal
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse - Oncopôle/Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France.,Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France.,INSERM U1037, Centre de Recherche contre le Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France
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Feuvret L, Antoni D, Biau J, Truc G, Noël G, Mazeron JJ. [Guidelines for the radiotherapy of gliomas]. Cancer Radiother 2016; 20 Suppl:S69-79. [PMID: 27521036 DOI: 10.1016/j.canrad.2016.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Gliomas are the most frequent primary brain tumours. Treating these tumours is difficult because of the proximity of organs at risk, infiltrating nature, and radioresistance. Clinical prognostic factors such as age, Karnofsky performance status, tumour location, and treatments such as surgery, radiation therapy, and chemotherapy have long been recognized in the management of patients with gliomas. Molecular biomarkers are increasingly evolving as additional factors that facilitate diagnosis and therapeutic decision-making. These practice guidelines aim at helping in choosing the best treatment, in particular radiation therapy.
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Affiliation(s)
- L Feuvret
- Service de radiothérapie, CHU Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg, France
| | - J Biau
- Département universitaire de radiothérapie, centre Jean-Perrin, Unicancer, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 1, France
| | - G Truc
- Département universitaire de radiothérapie, centre Georges-François-Leclerc, Unicancer, 1, rue Professeur-Marion, BP 77980, 21079 Dijon cedex, France
| | - G Noël
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg, France
| | - J-J Mazeron
- Service de radiothérapie, CHU Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Do perfusion and diffusion MRI predict glioblastoma relapse sites following chemoradiation? J Neurooncol 2016; 130:181-192. [DOI: 10.1007/s11060-016-2232-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 07/31/2016] [Indexed: 01/18/2023]
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Rieken S, Habermehl D, Giesel FL, Hoffmann C, Burger U, Rief H, Welzel T, Haberkorn U, Debus J, Combs SE. Analysis of FET-PET imaging for target volume definition in patients with gliomas treated with conformal radiotherapy. Radiother Oncol 2013; 109:487-92. [DOI: 10.1016/j.radonc.2013.06.043] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 06/23/2013] [Accepted: 06/24/2013] [Indexed: 11/17/2022]
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Martin V, Moyal É, Delannes M, Padovani L, Sunyach MP, Feuvret L, Dhermain F, Noël G, Laprie A. Radiothérapie des tumeurs cérébrales : quelles marges ? Cancer Radiother 2013; 17:434-43. [DOI: 10.1016/j.canrad.2013.07.136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 07/09/2013] [Indexed: 01/15/2023]
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Niyazi M, Geisler J, Siefert A, Schwarz SB, Ganswindt U, Garny S, Schnell O, Suchorska B, Kreth FW, Tonn JC, Bartenstein P, la Fougère C, Belka C. FET-PET for malignant glioma treatment planning. Radiother Oncol 2011; 99:44-8. [PMID: 21458093 DOI: 10.1016/j.radonc.2011.03.001] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Revised: 02/28/2011] [Accepted: 03/10/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to compare MRI-based morphological gross tumour volumes (GTVs) to biological tumour volumes (BTVs), defined by the pathological radiotracer uptake in positron emission tomography (PET) imaging with (18)F-fluoroethyltyrosine (FET), subsequently clinical target volumes (CTVs) and finally planning target volumes (PTVs) for radiotherapy planning of glioblastoma. PATIENTS AND METHODS Seventeen patients with glioblastoma were included into a retrospective protocol. Treatment-planning was performed using clinical target volume (CTV=BTV+20mm or CTV=GTV+20mm+inclusion of the edema) and planning target volume (PTV=CTV+5mm). Image fusion and target volume delineation were performed with OTP-Masterplan®. Initial gross tumour volume (GTV) definition was based on MRI data only or FET-PET data only (BTV), secondarily both data sets were used to define a common CTV. RESULTS FET based BTVs (median 43.9 cm(3)) were larger than corresponding GTVs (median 34.1cm(3), p=0.028), in 11 of 17 cases there were major differences between GTV/BTV. To evaluate the conformity of both planning methods, the index (CTV(MRT)∩CTV(FET))/(CTV(MRT)∪CTV(FET)) was quantified which was significantly different from 1 (0.73 ± 0.03, p<0.001). CONCLUSION With FET-PET-CT planning, the size and geometrical location of GTVs/BTVs differed in a majority of patients. It remains open whether FET-PET-based target definition has a relevant clinical impact for treatment planning.
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Affiliation(s)
- Maximilian Niyazi
- Department of Radiation Oncology, Ludwig-Maximilians-University Munich, München, Germany.
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Abstract
Glial tumors represent 2000 to 3000 new cases per year in France and 75% of them are of high grade. Recent understanding of the molecular biology of these tumors revealed the importance of 1p19q codeletion and mgMT promotor methylation. Radiotherapy also recently evolved with the progress in medical imaging which allows a better definition of the target volumes. Even modest, therapeutic progress is based on chemoradiotherapy with temozolomide and on the development of non-coplanar conformational radiotherapy. Knowledge and precise evaluation of potential late effects of our treatments is necessary due to actual improvement of survival with chemoradiotherapy in glioblastoma.
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Affiliation(s)
- S Haberer
- Service d'oncologie radiothérapique, centre des tumeurs, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Bondiau PY, Fauchon F, Jadaud E, Paquis P. [Radiotherapy in adult glioblastomas]. Neurochirurgie 2010; 56:486-90. [PMID: 20869090 DOI: 10.1016/j.neuchi.2010.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022]
Abstract
Radiation therapy is a treatment of malignant gliomas in adults. It improves survival rates, whether used alone, in addition to surgery, or in combination with chemotherapy. Three-dimensional imaging techniques, image fusion, and conformational radiotherapy are optimizing treatment plans for the treatment of these tumors and are sparing healthy tissue. After a review of the physical and biological bases of ionizing radiation, we present the techniques, results, side effects, and results of irradiation of glioblastomas.
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Affiliation(s)
- P-Y Bondiau
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06100 Nice, France.
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Abstract
"Dose-painting" radiotherapy allows for a heterogeneous delivery of radiation within the tumour volume by targeting radioresistant areas defined by functional imaging. Within gross tumour volume, it is possible to define one or more target volumes based on biology (biological target volume [BTV]) and to apply a strategy of intensity modulated radiation therapy (IMRT) that will deliver a higher dose to these regions. In this review of the literature, we will highlight the biological elements responsible for radioresistance, and how to image them, then we will detail the radiotherapy techniques necessary for this approach, before presenting clinical results in various situations (head and neck tumours, prostate, brain tumours, etc.). Despite many difficulties that make dose-painting IMRT unusable in routine nowadays, biology-guided radiation therapy represents one of the major pathways of development of radiotherapy in the coming years.
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Pardo J, Murcia M, García F, Alvarado A. Gliosarcoma: A rare primary CNS tumor. Presentation of two cases. Rep Pract Oncol Radiother 2010; 15:98-102. [PMID: 24376932 DOI: 10.1016/j.rpor.2010.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 05/04/2010] [Accepted: 05/28/2010] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Gliosarcoma is a very rare primary mixed tumor in the central nervous system, with a biphasic pattern consisting of glial and malignant mesenchymal elements. Its onset is between the fourth and sixth decade of life, and it has a male/female ratio of 1.8/1. Here we present two cases of Gliosarcoma treated in our department. DISCUSSION The monoclonal or biclonal origin of its biphasic nature is still subject to debate; hence the importance of its diagnosis and histogenesis. RESULTS Standard treatment consists in surgical resection of the tumor followed in some cases by external radiotherapy and chemotherapy.
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Affiliation(s)
- José Pardo
- CAPIO-Hospital General de Catalunya, Radiation Oncology, Pedro i Pons n° 1, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Mauricio Murcia
- CAPIO-Hospital General de Catalunya, Radiation Oncology, Pedro i Pons n° 1, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Felip García
- CAPIO-Hospital General de Catalunya, Pathology Department, Pedro i Pons n° 1, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Arnaldo Alvarado
- CAPIO-Hospital General de Catalunya, Radiation Oncology, Pedro i Pons n° 1, 08195 Sant Cugat del Vallès, Barcelona, Spain
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Prabhakar R, Ganesh T, Rath GK, Julka PK, Sridhar PS, Joshi RC, Thulkar S. Impact of Different CT Slice Thickness on Clinical Target Volume for 3D Conformal Radiation Therapy. Med Dosim 2009; 34:36-41. [DOI: 10.1016/j.meddos.2007.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 08/25/2007] [Accepted: 09/18/2007] [Indexed: 10/22/2022]
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Kantor G, Laprie A, Huchet A, Loiseau H, Dejean C, Mazeron JJ. [Radiation therapy for glial tumors: technical aspects and clinical indications]. Cancer Radiother 2008; 12:687-94. [PMID: 18926759 DOI: 10.1016/j.canrad.2008.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Radiotherapy of glial tumors is rapidly evolving with the recent technical and therapeutic progress. About technical aspects, progress in technical imaging and development of non-coplanar conformal and IMRT techniques provide new possibilities for sparing healthy tissue while increasing dose in tumoral volume. Furthermore, functional and molecular imaging are helpful for delineation and for prediction of relapse. Even modest, the actual improvement of survival with radiochemotherapy leads now to new and important developments for clinical research according to clinical data (age, general status), biological data (MGMT promotor methylation and cytogenetic modifications) and technical data (quality of surgery and radiotherapy). Understanding of molecular mechanisms allows for rational targeting or specific pathways of repair, signaling angiogenesis associated with surgery and radiotherapy in a multidisciplinary approach.
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Affiliation(s)
- G Kantor
- Service de radiothérapie, centre régional de lutte contre le cancer, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
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Radiothérapie des tumeurs gliales de l’adulte : actualités et perspectives. Rev Neurol (Paris) 2008; 164:531-41. [DOI: 10.1016/j.neurol.2008.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 03/20/2008] [Indexed: 11/18/2022]
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Calugaru V, Taillibert S, Lang P, Simon JM, Delattre JY, Mazeron JJ. Chimiothérapie néoadjuvante suivie d'une radiothérapie adaptée à la réponse tumorale dans les tumeurs germinales séminomateuses du système nerveux central: expérience de l'hôpital de la Pitié-Salpêtrière et revue de la littérature. Cancer Radiother 2007; 11:122-8. [PMID: 17459755 DOI: 10.1016/j.canrad.2007.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 12/30/2006] [Accepted: 01/09/2007] [Indexed: 11/20/2022]
Abstract
PURPOSE Retrospective analysis of ten cases of germinoma of the central nervous system treated in Pitié-Salpêtrière Hospital, Paris. PATIENTS AND METHODS Ten male patients were treated from 1997 to 2005 for histologically verified primary seminoma of the central nervous system. The median age was 27 years (range 18-40 years). Our option for the treatment was the association of 3-4 cycles of neoadjuvant chemotherapy (cisplatin and etoposide) to radiotherapy. Five patients received a craniospinal radiotherapy of 30 Gy (for one patient 36 Gy) followed by a tumoral boost from 20 to 24 Gy. For five patients, irradiated volume was limited to the tumour, total dose from 24 to 54 Gy (for three patients the total dose was from 24 to 30 Gy). Surgery was used for five patients, but only in one case was macroscopic complete. RESULTS Six patients were in situation of complete remission after neoadjuvant chemotherapy. All the patients were in situation of complete remission after the irradiation. All the patients were alive free of disease with a median follow-up 46 months (range 13-90 months). CONCLUSION In spite of the fact that the intracranial germinal tumours are not the subject of a consensual treatment strategy, this retrospective analysis pleads in favour of chemotherapy followed by limited dose and volume irradiation.
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Affiliation(s)
- V Calugaru
- Service de radiothérapie oncologique, groupe hospitalier de la Pitié-Salpêtrière, APHP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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