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Clinic of Neurosurgery
Clinical Center Niš
Bulevar dr Zorana Đinđića 48 18000 Niš, Serbia
UDC: 616.831-006:615.849 doi:10.5633/amm.2011.0301
Influence of peritumoral edema on the outcome of radiotherapy of supratentorial noncystic glioblastoma multiforme
Ivan Stefanović¹, Aleksandar Kostić¹, Miša Radisavljević1, Slađana Filipović² and Petar Bošnjaković³
Clinic of Neurosurgery, Clinical Centre Niš, Serbia1
Clinic of Oncology, Clinical Centre Niš, Serbia2
Institute of Radiology, Clinical Centre Niš, Serbia3
The lifetime of an OH radical is 10-5 sec., i.e. ten billion times longer than the lifetime of a free electron, and most authors stress its indirect mechanism of DNA destruction as a predominant one in the radiation treatment of glioblastoma multiforme (GBM). Although the concentration of OH radicals in brain edema is increased, the edema remodels the zone of tumor infiltration and prepares the ground for exterritorialization of tumor regions planned for irradiation, influencing the possibility of rapid recurrences.
The aim of the paper was to establish the impact of peritumoral edema on the time to recurrence of glioblastoma multiforme, survival, type and incidence of postirradiation complications.
Sixty patients with total resection of supratentorial noncystic GBM were treated after a month with 60 Gy of radiation therapy, out of which one half to the therapeutic volume (TV) and the other half to the clinical target volume (CTV), and upon completion all of them were given the BCNU protocol. According to the recommendations by RTOG (Radiation Therapy Oncology Group), surgically treated patients were divided into those with edema below 25 cm3; 25-75 cm3; and finally those over 75 cm3.
Patients with peritumoral edema of over 75 cm3 had statistically significantly faster relapse, had poorer Karnofsky score, progression of peritumoral edema, and higher mortality if radiotherapy was delivered only to the CTV. Dispersion of radiation in the TV does not reduce the incidence of cutaneous postirradiation effects and cannot be justified for edemas smaller than 25 cm3. Acta Medica Medianae 2011;50(3):5-9.
Key words: glioblastoma multiforme, radiotherapy, peritumoral edema, survival, radiation complications