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01.10.2014 | Original article

Clinical radiobiology of glioblastoma multiforme

Estimation of tumor control probability from various radiotherapy fractionation schemes

verfasst von: Piernicola Pedicini, Ph.D., Alba Fiorentino, Vittorio Simeon, Paolo Tini, Costanza Chiumento, Luigi Pirtoli, Marco Salvatore, Giovanni Storto

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 10/2014

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Abstract

Background and purpose

The aim of this study was to estimate a radiobiological set of parameters from the available clinical data on glioblastoma (GB).

Patients and methods

A number of clinical trial outcomes from patients affected by GB and treated with surgery and adjuvant radiochemotherapy were analyzed to estimate a set of radiobiological parameters for a tumor control probability (TCP) model. The analytical/graphical method employed to fit the clinical data allowed us to estimate the intrinsic tumor radiosensitivity (α), repair capability (b), and repopulation doubling time (T _d) in a first phase, and subsequently the number of clonogens (N) and kick-off time for accelerated proliferation (T _k). The results were used to formulate a hypothesis for a scheduleexpected to significantly improve local control. The 95 % confidence intervals (CI_95 %) of all parameters are also discussed.

Results

The pooled analysis employed to estimate the parameters summarizes the data of 559 patients, while the studies selected to verify the results summarize data of 104 patients. The best estimates and the CI_95 % are α = 0.12 Gy⁻¹ (0.10–0.14), b = 0.015 Gy⁻² (0.013–0.020), α/b = 8 Gy (5.0–10.8), T _d = 15.4 days (13.2–19.5), N = 1 · 10⁴ (1.2 · 10³–1 · 10⁵), and T _k = 37 days (29–46). The dose required to offset the repopulation occurring after 1 day (D _prolif) and starting after T _k was estimated as 0.30 Gy/day (0.22–0.39).

Conclusion

The analysis confirms a high value for the α/b ratio. Moreover, a high intrinsic radiosensitivity together with a long kick-off time for accelerated repopulation and moderate repopulation kinetics were found. The results indicate a substantial independence of the duration of the overall treatment and an improvement in the treatment effectiveness by increasing the total dose without increasing the dose fraction.

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Titel: Clinical radiobiology of glioblastoma multiforme
Estimation of tumor control probability from various radiotherapy fractionation schemes
verfasst von: Piernicola Pedicini, Ph.D.
Alba Fiorentino
Vittorio Simeon
Paolo Tini
Costanza Chiumento
Luigi Pirtoli
Marco Salvatore
Giovanni Storto
Publikationsdatum: 01.10.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 10/2014
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-014-0638-9

Springer Medizin

Clinical radiobiology of glioblastoma multiforme

Estimation of tumor control probability from various radiotherapy fractionation schemes