Trial Information

A Phase II Study of Hypofractionated Radiation With CyberKnife Stereotactic Radiosurgery Boost for High Grade Gliomas in Elderly Patients With Good Performance Status

Screening Procedures: Screening procedures are tests and procedures that will be done to
determine if you are eligible to take part in the research study. For this research study,
the screening procedures include: Medical history, physical examination including
neurological and performance status, assessment of preoperative and postoperative scans,
operative reports and pathology reports. All of these have already been performed or will be
performed as standard of care for your condition even if you are not taking part in this
study.

Research Procedures: If you qualify to take part in this research study, you will undergo
these research procedures: The pre- and post operative MRI (Magnetic Resonance Imaging)
scans before and after your operation, the operative procedure (including sampling known as
biopsy or removal of as much as tumor as possible) and the procedures to facilitate
radiation therapy planning (making a mask in the treatment position to keep you comfortably
still and CAT scan in the treatment position). These are all part of standard procedures in
the treatment of your tumor, whether you are in this study or not.

One of the primary reasons to deliver radiation in multiple small doses conventionally
(30-33 treatments over 6-61/2 weeks) is to minimize damage to the surrounding normal brain.
The Cyberknife technology allows precise delivery of radiation to your tumor while
minimizing radiation to the surrounding brain. This allows the possibility of delivering
higher doses of radiation to the tumor thereby shortening the overall treatment time (18
treatments in 31/2 weeks). This is what is being studied in this study.

The Cyberknife treatment will be longer in duration lasting about 30-60 minutes rather than
5-10 minutes with each conventional radiation treatment. During this time you will be asked
to lie as comfortably still as you can. The technology however permits the radiation beam to
adjust precisely to any small movements you may make to maintain the accuracy.

Along with radiation, you will get chemotherapy called Temozolomide, in the form of pills.
This is also standard treatment whether or not you are in this study. You will be asked to
take these pills every day during the course of radiation and for 5 days each month
thereafter for a year. However during radiation you will be receiving Temozolomide, which is
used to possibly make the radiation more effective, only for 4 weeks as opposed to 6 weeks
of conventional radiation. As part of usual care with this chemotherapy you may receive
supportive medication to prevent and treat nausea, vomiting, low blood counts or infection.

Monitoring/Follow-Up Procedures. Procedures performed to evaluate the effectiveness and
safety of the experimental procedures are called "monitoring" or "follow-up" procedures.
For this research study, the monitoring/follow-up procedures include: Clinical assessment
including neurological and performance status assessments and blood tests for your
chemotherapy will be performed every month for the first year and every three months
thereafter. MRI scans one month after completion of radiation therapy and every 2 months
thereafter. All these procedures are performed routinely in the management of your tumor