Principal Author, MD Second Author, MD PhD Third Author, MSc Institution, City, Country 23 January 2013.

Principal Author, MDSecond Author, MD PhD

Third Author, MScInstitution, City, Country

23 January 2013

Glioblastoma Multiforme (GBM) is the most common primary brain malignant neoplasm in adults

Despite constant attempts to improve outcome, the survival of patients with GBM remains limited

Currently, the standard of care consists of maximal safe surgical resection followed by External Beam Radiotherapy (EBRT) and concomitant TMZ followed by adjuvant TMZ

Post-operative EBRT: 60 Gy/30 daily fractions over 6 weeks PTV margins extending to 2 to 2.5 cm from

oedema/residual disease and surgical cavity Dose response curve

Souhami, L. et al, 2004.•RTOG 9305 for SRS boost in addition to conventional EBRT

Laperrière, N. et al, 1998.•Interstitial Implant in addition to conventional EBRT

IMRT Concomitant boost technique

•Shorten overall treatment time: reduces accelerated repopulation•Larger dose/fraction: increases cell killing

MRI co-registration Immobilization Treatment delivery verification

IGRT Limited margins: reduce the normal brain volume

irradiated Reduction of treatment-related toxicity

Temozolomide XRT+Temozolomide Temozolomide Neo-adjuvant TMZ: 75 mg/m² QD will be administered

for 2 weeks before starting radiotherapy Accelerated Radiotherapy: 60 Gy in 20 fractions over

4 weeks using IMRT concomitant boost technique Concurrent TMZ with accelerated hypofractionated

radiotherapy: 75 mg/m² QD for the whole duration of radiotherapy

Adjuvant TMZ: 150 mg/m² QD for 5 consecutive days of a 28 day-cycle