CNS Flashcards
Stupp 2009 Trial Logistics
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
Stupp 2009 Key Outcomes
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%
Stupp 2017 Trial Logistics
PRT
Patients: GBM
Randomized: EBRT + TMZ (Stupp regimen) vs. EBRT + TTF+TMZ
Stupp 2017 Trial Outcomes
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
RTOG 0825 Trial Logistics
PRT
Patients:
RTOG 0825 Trial Outcomes
RTOG 9802 Trial Logistics (LGG)
Prospective of low risk low grade (<40, GTR by NSGY) followed with surgery after GTR
RTOG 9802 Trial Outcomes (LGG)
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
RTOG 0424 Trial Logistics (LGG)
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
RTOG 0424 Trial Outcomes (LGG)
3 year OS; 73.1% and this was compared to historical control, much betters (p < 0.001)
3 year PFS: 59.2%
RTOG 9402 Trial Logistics (HGG)
Anaplastic oligodendroglial tumors after surgery to radiation alone or 4 cycles PCV then radiation
RTOG 9402 Trial Outcomes (HGG)
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)
EORTC 26951 Logistics
Ananplastic oligodendroglial to surgery and either radiation or radiation + 6 cycles PCV
EORTC 26951 Outcomes
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
NOA-04 Logistics
Randomized patient to radiation or chemotherapy Could cross over to treatment arms
NOA-4 outcomes
No significant benefit to either treatment modality upfront.
Roa 04 Logistics
100 patient with GBM with age > 60, KPS > 50 went to surgery and then either standard radiation and abbreviated radiation
Roa 04 Outcomes
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)
Perry 2017 Outcomes
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)
Perry 2017 Logistics
562 patients with GBM, > 65 who underwent surgery to either RT (short course) or RT (short course + temozolamide - concurrent and maintenance)
Roa 15 Logistics
Randomized 98 patients with GBM, age > 50 and KPS 50-70 vs frail + elderly + elderly to 25/5 vs 40/15
Roa 15 Outcomes
Median OS was similar (7.9 vs 6.4 months (0.988)
Median PFS was similar (4.2 vs. 4.2 p < 0.716)
RTOG 0539 Logisitcs
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
RTOG 0539 Outcomes
Believers Trial Logistics
343 patients to low dose (45Gy) vs high dose (59.4Gy) RT after surgery for LGG.
Non-Believers Trial
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
Believers Trial Outcomes
PFS (47 vs. 50%) AND OS were similar (58 vs 59%) were equivalent
Non-Believers Outcomes
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)
Brown 2017 Logistics
SRS vs WBRT following surgical resection for brain mets
Brown 2017 Outcomes
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)
ROTG 9005 Logistics
RTOG 9005 Outcomes
