<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec id="j_raon-2018-0023_s_002">
<h3>Background</h3>
<p>The current standard of care of glioblastoma, the most common primary brain tumor in adults, has remained unchanged for over a decade. Nevertheless, some improvements in patient outcomes have occurred as a consequence of modern surgery, improved radiotherapy and up-to-date management of toxicity. Patients from control arms (receiving standard concurrent chemoradiotherapy and adjuvant chemotherapy with temozolomide) of recent clinical trials achieve better outcomes compared to the median survival of 14.6 months reported in Stupp’s landmark clinical trial in 2005. The approach to radiotherapy that emerged from Stupp’s trial, which continues to be a basis for the current standard of care, is no longer applicable and there is a need to develop updated guidelines for radiotherapy within the daily clinical practice that address or at least acknowledge existing controversies in the planning of radiotherapy.</p>
<p>The goal of this review is to provoke critical thinking about potentially controversial aspects in the radiotherapy of glioblastoma, including among others the issue of target definitions, simultaneously integrated boost technique, and hippocampal sparing.</p>
</sec>
<sec id="j_raon-2018-0023_s_003">
<h3>Conclusions</h3>
<p>In conjunction with new treatment approaches such as tumor-treating fields (TTF) and immunotherapy, the role of adjuvant radiotherapy will be further defined. The personalized approach in daily radiotherapy practice is enabled with modern radiotherapy systems.</p>
</sec>
</abstract>

Background
The current standard of care of glioblastoma, the most common primary brain tumor in adults, has remained unchanged for over a decade. Nevertheless, some improvements in patient outcomes have occurred as a consequence of modern surgery, improved radiotherapy and up-to-date management of toxicity. Patients from control arms (receiving standard concurrent chemoradiotherapy and adjuvant chemotherapy with temozolomide) of recent clinical trials achieve better outcomes compared to the median survival of 14.6 months reported in Stupp’s landmark clinical trial in 2005. The approach to radiotherapy that emerged from Stupp’s trial, which continues to be a basis for the current standard of care, is no longer applicable and there is a need to develop updated guidelines for radiotherapy within the daily clinical practice that address or at least acknowledge existing controversies in the planning of radiotherapy.
The goal of this review is to provoke critical thinking about potentially controversial aspects in the radiotherapy of glioblastoma, including among others the issue of target definitions, simultaneously integrated boost technique, and hippocampal sparing.


Conclusions
In conjunction with new treatment approaches such as tumor-treating fields (TTF) and immunotherapy, the role of adjuvant radiotherapy will be further defined. The personalized approach in daily radiotherapy practice is enabled with modern radiotherapy systems.

Radiotherapy of glioblastoma 15 years after the landmark Stupp’s trial: more controversies than standards?

Department of Nuclear Medicine and PET Center

Department of Neurosurgery - St. Anne’s University Hospital Brno

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Background
The current standard of care of glioblastoma, the most common primary brain tumor in adults, has remained unchanged for over a decade. Nevertheless,...

Contouring approach	Dose prescription	GTV	CTV
EORTC single phase	30 × 2.0 Gy	Resection cavity + residual T1 enhancement	GTV + 2 cm
RTOG two phases	23 × 2.0 Gy	GTV1: Resection cavity + residual T1 enhancement + FLAIR abnormality (oedema)	CTV1 = GTV1 + 2 cm (the margin is 2.5 cm in cases where no oedema is presented)
	+ 7 × 2.0 Gy	GTV2: Resection cavity + residual T1 enhancement	GTV2 + 2 cm
ESTRO-ACROP	30 × 2.0 Gy	Resection cavity + residual T1 enhancement + FLAIR abnormality (oedema) for secondary glioblasomas	GTV + 2 cm

Radiotherapy of glioblastoma 15 years after the landmark Stupp’s trial: more controversies than standards?

Article Category: Review

Published Online: Jun 06, 2018

Page range: 121 - 128

Received: Nov 07, 2017

Accepted: Mar 12, 2018

DOI: https://doi.org/10.2478/raon-2018-0023

© 2018 Tomas Kazda, Adam Dziacky, Petr Burkon, Petr Pospisil, Marek Slavik, Zdenek Rehak, Radim Jancalek, Pavel Slampa, Ondrej Slaby, Radek Lakomy, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Recommendations for target definition according to EORTC, RTOG and ESTRO-ACROP