Stereotactic Radiosurgery and Radiation Therapy in Treating Patients With Glioblastoma Multiforme

RATIONALE: Stereotactic radiosurgery may be able to send x-rays directly to the tumor and cause less damage to normal tissue. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving stereotactic radiosurgery together with radiation therapy may kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving stereotactic radiosurgery together with radiation therapy works in treating patients with glioblastoma multiforme.

OBJECTIVES:

Primary

* Determine the feasibility and efficacy of stereotactic radiosurgery to high-risk tumor regions and conventional radiotherapy in patients with glioblastoma multiforme.
* Determine overall survival of patients treated with this regimen.

Secondary

* Determine 6-month progression-free survival of patients treated with this regimen.
* Determine the absence of tumor growth and/or activity on conventional MR/MR spectroscopy imaging in patients treated with this regimen.
* Determine the frequency and severity of RTOG (Radiation Therapy Oncology Group) CNS toxic effects in patients treated with this regimen.
* Determine the neurologic function and quality of life of patients treated with this regimen.

OUTLINE: This is a pilot study.

Patients undergo stereotactic radiosurgery to high-risk areas of active tumor determined by MR-spectroscopy. No more than 2 weeks later, patients undergo conventional radiotherapy once daily, 5 days a week, for 6 weeks.

Quality of life is assessed at baseline, weekly during radiotherapy, at 1 and 3 months after completion of radiotherapy, and then every 3 months for 2 years, every 6 months for 3 years, and annually thereafter.

After completion of study treatment, patients are followed periodically for at least 5 years.

PROJECTED ACCRUAL: A total of 35 patients will be accrued for this study.

Eligibility Criteria:
DISEASE CHARACTERISTICS:

* Histologically confirmed grade IV malignant glioblastoma multiforme

  * Diagnosis by surgical biopsy or resection within the past 5 weeks
* Post-operative diagnostic contrast-enhanced MRI scan with MR spectroscopy must be performed prior to initiating study treatment

  * High-risk area of active tumor without margin by MR spectroscopy

    * Meets the following criteria for radiosurgery:

      * Maximum diameter ≤ 40 mm
      * Located \> 5 mm from the optic nerve or chiasm
      * Does not involve the brainstem
* No multifocal or recurrent malignant glioma

PATIENT CHARACTERISTICS:

Performance status

* Karnofsky 50-100%

Life expectancy

* At least 3 months

Hematopoietic

* Not specified

Hepatic

* Not specified

Renal

* Not specified

Other

* Not pregnant
* Negative pregnancy test

PRIOR CONCURRENT THERAPY:

Chemotherapy

* At least 6 weeks since chemotherapy
* Concurrent chemotherapy allowed

Endocrine therapy

* Concurrent steroids allowed, but at the smallest therapeutic dose possible

Radiotherapy

* No prior in-field radiotherapy to the head and neck

Surgery

* See Disease Characteristics
* Recovered from prior surgery or any post-operative complication

Other

* Concurrent antiseizure medications allowed