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Is it acceptable to treat glioblastoma with upfront SRS instead of fractionated external beam RT?
Our neurosurgeons have been pushing for definitive and postop SRS in patients with a poor performance status. Should I consider this or is it totally outside the standard of care?
Answer from: Radiation Oncologist at Community Practice
There is good prospective randomised data in this setting for using hypofractionated RT alone (34/10 fractions or 40/15 fractions) or Temodar alone (if MGMT methylated). If the goal is palliation and QOL improvement, either of the two based on the clinical situation is a viable option.There is no go...
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Answer from: Radiation Oncologist at Community Practice
I agree that in cases of GBM, there is not good published study data supporting SRS as a boost. I believe RTOG looked at this. Is is mainly indicated as a "palliative tool" when there is recurrence.
Answer from: Radiation Oncologist at Academic Institution
I believe that SRS for up-front GBM should only be given in the context of a phase I protocol, since the previous data all suggest that SRS adds no value to disease control. If the patient has poor KPS, I always encourage hypofrac regimens as brief as 300x10; and if they are truly ultra poor KPS, th...
Answer from: Radiation Oncologist at Academic Institution
I agree with the above statements. It is hard to justify SRS as palliative measure when the RTOG 9305 protocol which used SRS as an upfront boost failed to show a benefit in any clinical measure (http://www.ncbi.nlm.nih.gov/pubmed/15465203). The multiple published hypofractionated palliative approac...