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Critical Appraisal of Experimental Radiation Modalities for Malignant Astrocytomas

Published online by Cambridge University Press:  18 September 2015

N.J. Laperriere
N.J. Laperriere*
Affiliation:
Department of Radiation Oncology, Princess Margaret Hospital, Toronto
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Abstract:

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The management of patients with supratentorial malignant astrocytomas has remained a major problem. Patients continue to die from a lack of local control in 90% of cases despite an improvement of median survival seen with the use of postoperative radiation therapy. Because of this, there has been considerable interest in exploring novel ways of possibly improving results. This paper reviews the rationale and clinical results with the use of altered fractionation schemes, brachytherapy, radiation sensitizers, hyperthermia, particle therapy, and radiosurgery in the treatment of these patients. Currently, there is no demonstrated advantage with the use of these experimental modalities in the initial management of patients. There would appear to be some benefit for selected patients who are treated with brachytherapy at recurrence, but its efficacy as part of initial management remains to be determined in ongoing randomized prospective trials.

Résumé:

RÉSUMÉ:

Le traitement des patients porteurs d'astrocytomes malins sus-tentoriels demeure un problème majeur. Ces patients continuent de mourir par manque de contrôle de la tumeur locale dans 90% de cas, malgré une amélioration de la survie médiane constatée avec l'emploi de la radiothérapie postopératoire. C'est ce qui a suscité un vif intérêt dans l'exploration de nouveaux moyens pouvant possiblement améliorer les résultats. Cet article revoit la justification et les résultats cliniques obtenues avec l'utilisation de plans modifiés de fractionnement de la radiothérapie, de brachythérapie, de radio-sensibilisateurs, d'hyperthermie, de thérapie particulaire, et de radiochirurgie dans le traitement de ces patients. Il n'y a actuellement aucune preuve que l'utilisation de ces modalités thérapeutiques expérimentales soit avantageuse dans la conduite initiale du traitement chez ces patients. Actuellement, il semblerait y avoir un réel bénéfice pour un groupe sélectionné de patients qui sont traités par brachythérapie au moment d'une récidive. Cependant, l'efficacité de cette modalité thérapeutique dans la conduite initiale du traitement reste à déterminer par des études prospectives randomisées présentement encours.

Type
Neurosurgical Symposium - William S. Keith, Visiting Professorship in Neurosurgery
Information
Canadian Journal of Neurological Sciences , Volume 17 , Issue 2 , May 1990 , pp. 199 - 208
Copyright
Copyright © Canadian Neurological Sciences Federation 1990

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