Glioblastoma is the deadliest form of primary brain cancer, largely due to its aggressive growth and resistance to treatment. The tumor infiltrates healthy brain tissue with hair-like extensions, complicating surgical removal. Surgeons face the delicate task of excising as much of the tumor as possible while safeguarding vital brain regions that control essential functions like movement and speech. Moreover, the tumor's complex cellular structure and its ability to evade conventional therapies add to the difficulty of treating the condition. While standard radiation therapy is commonly employed and can be effective, it also carries the risk of damaging healthy brain tissue, leading to unintended side effects. Now, a new treatment strategy combining advanced imaging may offer improved survival rates for older patients with newly diagnosed glioblastoma, all while preserving their quality of life.

Mayo Clinic (Rochester, MN, USA) has shared the findings from its phase 2, single-arm study using one of the most innovative radiation treatments available today—proton beam therapy. This advanced, nonsurgical radiation therapy targets cancer cells with remarkable precision while minimizing damage to surrounding healthy tissue. The study focused on patients over the age of 65 who had been newly diagnosed with WHO grade 4, malignant glioblastoma. In the SAGA clinical trial (Stereotactic Ablative Radiation Treatment for Glioblastoma), the research team utilized short-course hypofractionated proton beam therapy, enhanced by advanced imaging techniques. These included 18F-DOPA PET and contrast-enhanced MRI, which helped map the target area in the patient's brain and identify the most metabolically active regions of the tumor. By combining these imaging technologies, the team was able to deliver treatment in just one to two weeks, compared to the usual three to six weeks.

The results of the study published in The Lancet Oncology showed that 56% of participants survived for 12 months, with a median overall survival of 13.1 months. The combination of advanced imaging and proton beam therapy allowed for more precise radiation delivery, sparing healthy brain tissue from unnecessary exposure. The patients tolerated the treatment well, with survival outcomes exceeding expectations. This study was the first clinical trial to investigate short-course hypofractionated proton beam therapy, incorporating advanced imaging techniques, for older patients with newly diagnosed glioblastoma. Following these promising results, Mayo Clinic has initiated a larger, randomized clinical trial.

“As compared to prior phase 3 studies in an older population having a median survival of only six to nine months, these results are promising," said Sujay Vora, M.D., radiation oncologist at Mayo Clinic, who led the research team. "In some cases, patients with tumors that have favorable genetics lived even longer, with a median survival of 22 months. We are very excited about these results."

"Our goal is to transform the way we treat glioblastoma using shorter courses of radiation to minimize the burden on patients and their families and help them complete safe and effective treatment in a shorter amount of time," added William Breen, M.D., radiation oncologist and principal investigator of the current study. 

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