P18.02 Prospective evaluation of quality of life in patients with recurrent high grade glioma treated with re-irradiation by tomotherapy based IMRT

Abstract

Abstract Introduction: Prospective quality of life (QOL) evaluation in re-irradiation (reRT) for recurrent high grade glioma (HGG) is rare but an important endpoint. We report a prospective study of patient reported QOL and activities of daily living (ADL) as primary end point in patients treated with re-irradiation (reRT) for recurrent HGG. Materials and Methods: 34 patients of recurrent HGG with Karnofsky Performance Status (KPS) ≥60 planned for re-irradiation as per joint neuro-oncology meeting decision were included. Image guided intensity modulated radiotherapy (IG-IMRT) was delivered with helical tomotherapy at 1.8 Gy/fraction to 45-55 Gy. Serial QOL and ADL evaluation was done by a trained occupational therapist using validated Indian translations of EORTC QLQ30 + BN20 and Barthel’s ADL Index, before starting reRT and at 1,3,6,9 and 12 months follow up post reRT. Results: At recurrence, 56% HGG were grade 3 and 44% were grade 4 tumours. 65% patients had HGG transformed from a previous low grade glioma. Before reRT, 74% patients had undergone re-surgery and 59% had received salvage chemotherapy with either temozolomide or bevacizumab. Median interval from primary RT was 6.7 years. Planned reRT dose was completed by 91% patients, with 27% requiring treatment interruption. Concurrent chemotherapy was planned for 77% patients, of which 27% required early cessation due to poor tolerance. Concurrent corticosteroid support was required by 41% patients. QOL questionnaires were completed by patients themselves in 85% instances while 15% were filled in proxy by primary caregivers. Mean baseline global QOL score was 61/100, which remained stable up to 50.5/100 at 6 months post reRT. Global QOL was stable in 15/25 patients at 1 month, 13/20 at 3 months, 7/16 at 6 months and 4/10 patients at 1 year post RT. Mean physical and social function scores were stable till 6 months. Emotional, role and cognitive function scores remained stable till 9 months. Mean baseline ADL score was 16.5/20, declining to 14/20 at 9 months post reRT. Among symptom scores, appetite loss and seizures remained stable till 3 months while scores for fatigue, insomnia and weakness of legs were stable till 6 months. Scores for motor dysfunction, communication deficit, nausea and bladder control remained stable till 9 months. Remaining symptom scores showed no significant decline till 1 year post RT. Pseudo progression was seen in 9/34 patients. At the time of analysis, 17/34 patients are alive and on follow-up. Decline in QOL scores at 6 to 9 months coincided with a median progression free survival of 36.5 weeks. Median overall survival was 46.5 weeks. Serial QOL and ADL scores did not correlate significantly with age, sex, KPS, tumour location and grade. CONCLUSION: Clinical experience of re-irradiation in recurrent HGG with IG-IMRT has been encouraging in terms of tolerance and palliation, providing reasonably stable QOL till tumour progression.