Top Line: Does dose escalation with intraoperative radiation in additional to standard chemoradiation improve outcomes in patients with GBM?
The Study: Glioblastoma has stubbornly resisted decades of efforts to improve outcomes through radiation dose escalation. INTRAGO-II was a phase 3 trial of 314 patients with supratentorial GBM amenable to resection. Intraoperatively, they were randomized to receive intraoperative RT or not. Intraoperative RT was administered using INTRABEAM, which is an electronic brachytherapy device that uses low energy x rays. The recommended dose was 30 Gy to the surface with reductions to 20 Gy allowed. Roughly two-thirds of patients in each arm had gross total resection. After surgery, patients in both arms went on to receive standard radiation (60 Gy in 30 fractions) and temozolomide. The addition of intraoperative RT did not significantly improve median PFS (11 v 11.4 months). There was also no difference in median OS (17.7 v 18.7 months). The most common site of recurrence was local and within 1 cm of the resection cavity in both groups (72% v 71%). The rate of radionecrosis was 7% in the intraop RT arm and 2% in the standard arm.
TBL: Does escalation with intraoperative RT for resected GBM does not reduce recurrence risk or improve survival outcomes. | Giordano, Lancet Oncol 2026
The Study: Glioblastoma has stubbornly resisted decades of efforts to improve outcomes through radiation dose escalation. INTRAGO-II was a phase 3 trial of 314 patients with supratentorial GBM amenable to resection. Intraoperatively, they were randomized to receive intraoperative RT or not. Intraoperative RT was administered using INTRABEAM, which is an electronic brachytherapy device that uses low energy x rays. The recommended dose was 30 Gy to the surface with reductions to 20 Gy allowed. Roughly two-thirds of patients in each arm had gross total resection. After surgery, patients in both arms went on to receive standard radiation (60 Gy in 30 fractions) and temozolomide. The addition of intraoperative RT did not significantly improve median PFS (11 v 11.4 months). There was also no difference in median OS (17.7 v 18.7 months). The most common site of recurrence was local and within 1 cm of the resection cavity in both groups (72% v 71%). The rate of radionecrosis was 7% in the intraop RT arm and 2% in the standard arm.
TBL: Does escalation with intraoperative RT for resected GBM does not reduce recurrence risk or improve survival outcomes. | Giordano, Lancet Oncol 2026