ABSTRACT
Early studies of abbreviated RT and high doses per fraction were conducted with patients with an especially poor prognosis, including elderly patients and those with a poor performance status (Roa et al., 2004; Hingorani et al., 2012). Recent prospective e‰orts have taken advantage of intensity modulation and simultaneous integrated boost capabilities to study hypofractionation in less selected populations. Floyd et al. (2004) reported on 20 patients treated with 50 Gy delivered in 5 Gy daily fractions to the enhancing disease and simultaneous 30 Gy in 3 Gy daily fractions to the surrounding edema and showed low survival and signi‚cant rates of radiation necrosis requiring surgical excision. Investigators from the University of Colorado reported on a phase I dose escalation trial (Chen et al., 2011) and subsequent phase II trial delivering dose-painted 30-60 Gy in 10 fractions with concurrent temozolomide (Reddy et al., 2012). Median survival was comparable to rates achieved in the Stupp trial, although four out of six patients who underwent surgical excision for suspected recurrence were found to have >80% necrosis.
