Concomitant accelerated hyper-fractionated radiotherapy and temozolomide in the treatment of high grade astrocytoma: Updated results

Abstract

11523 Background: The safety and efficacy of accelerated hyper-fractionated radiotherapy (RT) combined with temozolomide (TMZ) in patients with high grade astrocytoma have already been reported.Updated results on survival will be presented. Methods: Twenty-four patients with newly diagnosed and histologically proven high grade astrocytoma were enrolled onto this study. Treatment protocol included RT delivered in fractions of 150 cGy 3 times daily with at least 4-hour intervals between fractions to a total dose 4050 cGy. The target volume was the tumor plus the edema with a 2-cm margin. A boost of 1800 cGy was given to the tumor plus a 2-cm margin to a total dose of 5850 cGy delivered in 39 sessions over 2.5 weeks. TMZ dose was (150 g/m2/day 7 d/wk) given 2 hours prior to RT, throughout the course of RT. Results: Of the 24 patients included 5 (21%) developed G2 & G3 neutropenia, and 4 patients (17%) developed G2 & G3 thrombocytopenia. Non-hematologic toxicities were: G2 & G3 vomiting in 8 (33%) patients, G2 & G3 fatigue in 13 (54%) patients, G2 skin rash in 4 (17%), and G2 acute radiation reaction in 2 (8%) patients. The12 months and 18 months survival rates were 67% and 51.5% respectively. Patients aged <45 years and those who underwent debulking surgery had better survival rates (69% & 70%) in comparison to those aged ≥45 years and those who underwent biopsy only (27% & 36%). Conclusions: The results achieved particularly with respect to survival are promising and should be confirmed. No significant financial relationships to disclose.