Clinical Trial Finder

Inclusion Criteria:

• - Newly diagnosed histologically-confirmed supratentorial World Health Organization (WHO) grade IV gliomas including glioblastoma multiforme and gliosarcoma.

• - Age 18 or older.

• - Karnofsky performance status (a measure to quantify general well being and activities of daily life; scale ranges from 0 to 100 where 100 is perfect health) of greater than or equal to 70.

• - Life expectancy of at least 12 weeks.

• - Adequate bone marrow reserve (hemoglobin greater than or equal to 10, absolute neutrophil count greater than or equal to 1500, platelets greater than or equal to 100,000); acceptable liver function (total bilirubin less than or equal to 2.0 mg/dl, ALT (Alanine Aminotransferase)/AST (Aspartate Aminotransferase) less than or equal to 5 times the normal range); acceptable renal function (serum creatinine less than or equal to 2.0 mg/dl).

Eligibility level for hemoglobin may be reached by transfusion.

• - Maximal contiguous volume of tumor based on high b-value diffusion MRI < 1/3 volume of brain.

• - Patients must be registered within 6 weeks of most recent resection.

• - Patients must have signed a study-specific informed consent.

Exclusion Criteria:

• - Recurrent glioma, or tumor involving the brainstem or cerebellum.

Prior low-grade glioma without prior RT, now with malignant progression are eligible.

• - Prior use of Gliadel wafers or any other intratumoral or intracavitary treatment is not permitted.

Prior chemotherapy for a different cancer is allowable, except for Temozolomide or Bevacizumab.

• - Evidence of cerebrospinal fluid dissemination (positive cerebrospinal fluid cytology for malignancy or MRI findings consistent with CSF dissemination) - Evidence of severe concurrent disease requiring treatment.

• - Prior invasive malignancy (except non-melanoma skin cancer) unless disease-free for a minimum of 3 years (for example, carcinoma in situ of breast, oral cavity or cervix are all permissible) - Patients unable to undergo Magnetic Resonance Imaging exams (MRI) (i.e. patients with non-compatible devices such as cardiac pacemakers, other implanted electronic devices, metallic prostheses, or ferromagnetic prostheses (e.g. pins in artificial joints and surgical pins/clips) or unable to receive gadolinium for MRI, as per the standard UM Department of Radiology MRI screening criteria) - Patients treated with previous cranial or head/neck radiotherapy leading to radiation field overlap.

• - Females of child-bearing potential must have a negative pregnancy test within 14 days prior to registration.

Patients with reproductive potential must agree to use an effective contraceptive method during treatment.

After analysis demonstrated the improved prognostic value of identifying both hypercellular tumor (TVHCV) based on high b-value diffusion-weighted magnetic resonance imaging (DW-MRI) and hyperperfused tumor (TVCBV) based on dynamic contrast-enhanced MRI (DCE-MRI), the study was amended and later-enrolled patients boosted to both TVHCV and TVCBV.

Arms

Experimental: High Dose Chemoradiation

Patients will receive high dose radiation based in part on advanced imaging, and concurrent temozolomide. Four weeks after the completion of chemoradiation, patients will receive adjuvant temozolomide.

Interventions

Radiation: - High Dose Radiation

Radiation will be delivered once daily for a total of 30 fractions, five days per week.

Drug: - Temozolomide

Patients will receive concurrent temozolomide (75 mg/m^2 daily for 6 weeks). Adjuvant temozolomide will be given at 150-200 mg/m^2, D1-5 every 28 days for a minimum of six cycles and will be started approximately four weeks following completion of radiotherapy.