Featured Case Studies 2004, Volume 1, Number 1

Glioblastoma Multiforme: Improving Quality of Life with Intensity Modulated Radiotherapy (IMRT)

by > John Breneman, MD and Ron Warnick, MD

Clinical problem

This previously healthy 45-year-old woman presented to the emergency department with her first grand mal seizure. An MR scan showed an enhancing, partially necrotic lesion in the left posterior frontal lobe. A gross total excision of the lesion was performed which was pathologically confirmed to be a glioblastoma multiforme.


Treatment options

Glioblastoma multiforme requires multi-modality treatment, beginning with maximal surgical resection. Following surgery, radiotherapy is given to the tumor bed and surrounding brain tissue. The volume targeted with radiation is the radio-graphically involved tissue based upon T2 or FLAIR images, plus a 1 to 2 cm margin to account for potential sub-clinical extension of disease. A radiation dose of 60 Gy is given using 2 Gy daily fractions. Concurrent or sequential administration of an alkylating chemotherapy agent with the ability to cross the blood-brain barrier (typically BCNU or temozolamide) prolongs survival in patients under age 50. Median survival for these patients is approximately 1 year, though many patients can survive substantially longer with aggressive follow-up and re-treatment of recurrent disease (1).


Figure 1. IMRT allows delivery of highly conformal radiotherapy to complex tumor volumes, minimizing the risks and side effects of treatment.

Comments

Quality of life issues are very important for these patients – most of whom cannot be cured of their tumor. Oral chemotherapy regimens using temozolamide are usually well tolerated and can be taken by the patient at home. Radiation side effects are related to the volume of normal tissue that is incidentally included in the treatment field. New radiotherapy techniques such as intensity-modulated radiotherapy (IMRT) offer improvements in normal tissue sparing compared to more conventional techniques such as 3D conformal radiotherapy (2). This results in less treatment-related fatigue and hair loss, and a smaller risk for radiation injury to normal brain.


References

1. Fiveash JB, Spencer SA. Role of radiation therapy and radiosurgery in glioblastoma multiforme. Cancer J 9(3):222-9, 2003.

2. Chan MF, Schupak K, Burman C, Chui CS, Ling CC. Comparison of intensity-modulated radiotherapy with three-dimensional conformal radiation therapy planning for glioblastoma multiforme. Med Dosim 28(4):261-5, 2003.


How to refer

Because of the specific nature and complexity of the services we provide, patients must have a consultation with one of our physicians prior to being referred to the center. To schedule an appointment with one of our physicians, please contact Precision Radiotherapy at 513-475-7777.