The treatment of brain stem and XXXX with 78 Gy of hyperfractionated radiation therapy.

@entity1 @entity5 @entity11 @entity9479 @entity204
PURPOSE: To see whether increasing the dose of hyperfractionated radiation therapy from 72 to 78 Gy would increase survival time in @entity1 with @entity11 , particularly those with brain stem or @entity5 . METHODS: Seventy-eight @entity1 with a clinical and radiographic diagnosis of a brain stem or thalamic @entity11 were enrolled in a trial to receive 78 Gy (1.0 Gy twice a day). Six @entity1 with disease in other sites were also treated. The initial response to therapy was determined by comparing pretreatment magnetic resonance images and neurological examinations with those obtained within 2 weeks of completing therapy; subsequent responses were determined from bimonthly follow-up images. Time-to- @entity5 progression was measured from the date radiation therapy began until the date of documented radiographic or clinical progression. Survival time was measured from the date radiation therapy began until the date of @entity204 . Cox proportional hazards analysis was used to estimate the effects of specific variables on survival. RESULTS: Of 81 evaluable @entity1 , 68 received > or = 76 Gy, 10 received between 70 and 75 Gy, and 3 received between 60 and 68 Gy. The overall response or stabilization rate was 70.4%. @entity5 size decreased in 30.8% of @entity1 ; 39.5% had stable disease, and 29.6% had immediate progression. The median survival time was 12.7 months (16.1 months for adults and 10.8 months for @entity1 ). The median time to @entity5 progression was 9.0 months (11.4 months for adults and 8.4 months for @entity1 ). A duration of symptoms < or = 2 months and a diffuse lesion were each associated with shorter survival and progression times. CONCLUSIONS: For @entity1 with brain stem or @entity9479 , increasing the dose of radiation therapy from 72 to 78 Gy did not significantly improve survival. Different treatment strategies are clearly needed.
