CNS

Question 1

Stupp 2009 Trial Logistics

Answer 1

PRT
Patients: GBM, 18-70, ECOG 0-2
Randomized: EBRT 60/30 or EBRT 60/30 + TMZ 75mg then adjuvant TMZ 100-200 d1-5 q4 weeks x 6 cycles

Question 2

Stupp 2009 Key Outcomes

Answer 2

Overall survival and PFS improved
MGMT prognostic factor
Survival: RT vs. RT + TMZ
MS: 12.1 mos vs 14.6 mos
2 year PFS: 1.8% vs 11.2%
2 year OS: 10.9% vs 27.2%
5 year OS: 1.9% vs. 9.8%

Question 3

Stupp 2017 Trial Logistics

Answer 3

PRT
Patients: GBM
Randomized: EBRT + TMZ (Stupp regimen) vs. EBRT + TTF+TMZ

Question 4

Stupp 2017 Trial Outcomes

Answer 4

Overall survival and PFS improved
Survival: RT+ TMZ vs. RT + TMZ + TFF
MFU: 40 months
OS: 20.9 months vs 16.0 months
PFS: 6.78 months vs. 2.0 months

Question 5

RTOG 0825 Trial Logistics

Answer 5

PRT
Patients:

Question 6

RTOG 0825 Trial Outcomes

Question 7

RTOG 9802 Trial Logistics (LGG)

Answer 7

Prospective of low risk low grade (<40, GTR by NSGY) followed with surgery after GTR

Question 8

RTOG 9802 Trial Outcomes (LGG)

Answer 8

OS at 2 and 5 years: 99% and 93%
PFS at 2 and 5 years: 82 and 48%
Predictive factors: Tumor > 4cm
Astrocytoma/oligoastrocytoma histology
Residual tumor > 1 cm

Question 9

RTOG 0424 Trial Logistics (LGG)

Answer 9

Phase 2 of 54Gy + concurrent and adjuvant TMZ for high risk LGG with 3 or more RFs for recurrence:
Factors are as follows:
Size > 6cm, astrocytoma/mixed histology, age > 40, tumor crosses midline, pre-operative neurological deficits
Results were compared to historical controls
Median F/u 4.1 years
129 patients

Question 10

RTOG 0424 Trial Outcomes (LGG)

Answer 10

3 year OS; 73.1% and this was compared to historical control, much betters (p < 0.001)
3 year PFS: 59.2%

Question 11

RTOG 9402 Trial Logistics (HGG)

Answer 11

Anaplastic oligodendroglial tumors after surgery to radiation alone or 4 cycles PCV then radiation

Question 12

RTOG 9402 Trial Outcomes (HGG)

Answer 12

No difference in median survival (4.6 yrs PCV vs. 4.7 yrs RT)
Subgroup of 1pq19 deleted there was doubling of median survival
when treated with PCV + RT 14.7 vs. 7.3 years (p = 0.03)
Non-co-deleted did not have a difference (2.6 vs 2.7 yrs)

Question 13

EORTC 26951 Logistics

Answer 13

Ananplastic oligodendroglial to surgery and either radiation or radiation + 6 cycles PCV

Question 14

EORTC 26951 Outcomes

Answer 14

Median f/u: 140 months
OS in RT/PCV was 42.3 vs 30.6 in RT alone (.6-.95 CI)
Significant benefit for 1pq19 co-deleted groups for PFS
Trend toward increase in OS in both with PCV but not significant

Question 15

NOA-04 Logistics

Answer 15

Randomized patient to radiation or chemotherapy Could cross over to treatment arms

Question 16

NOA-4 outcomes

Answer 16

No significant benefit to either treatment modality upfront.

Question 17

Roa 04 Logistics

Answer 17

100 patient with GBM with age > 60, KPS > 50 went to surgery and then either standard radiation and abbreviated radiation

Question 18

Roa 04 Outcomes

Answer 18

OS was similar (5.1 months for 60Gy vs. 5.6 months for 40 Gy, p = 0.57)
No difference in KPS score changes
Patients did require more steroids in 60Gy group (p =0.02)

Question 19

Perry 2017 Outcomes

Answer 19

Median OS was greater for temozolamide arm as compared to short course RT only (9.3 vs. 7.6 months, p <0.001)
Mediant PFS was greater for temozolamide arm as compared to short course RT (5.3 vs. 3,9 months, p< 0.001)
MGMT hypermethylated, OS was benefit with 13.5 months vs. 7.7 months (p < 0.001)
Unmethylated MGMT: 10.0 vs. 7.9 months, p < 0.055 (trend towards significance)

Question 20

Perry 2017 Logistics

Answer 20

562 patients with GBM, > 65 who underwent surgery to either RT (short course) or RT (short course + temozolamide - concurrent and maintenance)

Question 20

Roa 15 Logistics

Answer 20

Randomized 98 patients with GBM, age > 50 and KPS 50-70 vs frail + elderly + elderly to 25/5 vs 40/15

Question 21

Roa 15 Outcomes

Answer 21

Median OS was similar (7.9 vs 6.4 months (0.988)
Median PFS was similar (4.2 vs. 4.2 p < 0.716)

Question 22

RTOG 0539 Logisitcs

Answer 22

Phase 2 trial of patients stratified to low risk (GTR/STR G1 meningioma), intermediate risk (GTR G2, recurrent G1)
or high risk (STR G2, recurrent G2, any G3)
Low risk got observed, Intermediate risk got 54Gy, High risk got 60Gy + 1 cm CTV and 54Gy 2cm CTV. PTV was 3-5mm

Question 23

RTOG 0539 Outcomes

Question 24

Believers Trial Logistics

Answer 24

343 patients to low dose (45Gy) vs high dose (59.4Gy) RT after surgery for LGG.

Question 25

Non-Believers Trial

Answer 25

Delay RT until progression after surgery. RT was 54Gy (45 Gy to pre-op bed + 2cm) with 9Gy boost and 1 cm exp). Non RT had CT scans q 4 months

Question 26

Believers Trial Outcomes

Answer 26

PFS (47 vs. 50%) AND OS were similar (58 vs 59%) were equivalent

Question 27

Non-Believers Outcomes

Answer 27

Median PFS: 5.3 yrs for RT, 3.4 years for delayer , p = 00001
5 years PFS: 55% for RT, 35% for delayed RT
Median OS: 7.4 vs. 7.2 years (delayed)

Question 28

Brown 2017 Logistics

Answer 28

SRS vs WBRT following surgical resection for brain mets

Question 29

Brown 2017 Outcomes

Answer 29

SRS had better cognitive free survival and cognitive deterioration at 5 months. No difference in SRS compared wo WBRT LC )79.2 vs 86.5% 12 month LC, p = 0.099)

Question 30

ROTG 9005 Logistics

Question 31

RTOG 9005 Outcomes