Abstract
Purpose: To evaluate the efficacy and safety of hypofractionated radiotherapy in treatment of patients with high grade glioma. Patients and Methods: A total of thirty patients with high grade glioma referred to clinical oncology and nuclear medicine department, Zagazig University Hospitals between July 2012 to January 2014. All patients were treated with three dimensional (3D) conformal hypofractionated radiotherapy at a dose of 45 Gy/15f treatments over 3 weeks for cases with gross total excision followed by 9Gy in 3 fractions for cases with subtotal excision and biopsy. Results: The median age was 53 years (range 26-66). The median follow up was 12.23 months (range: 4-22 months). One-year overall survival (OAS) and progression free survival (PFS) rates were 58.9% and 12%, respectively. In univariate analysis, age ≥50 years, poor performance status (Karnofasky score of ≥50-70%). Grade IV histology, subtotal excision and overall response to treatment was all associated with statistically significant reduction in OAS and PFS rates. Multivariate analysis, showed that age 70 were the only independent prognostic factors that were associated with good OAS (p= 0.010 and p= 0.015, respectively), and grade III and overall response were the only prognostic factors associated with good PFS (p= 0.002 and p=0.014, respectively). There were minimal side effects to radiation therapy, and all patients complete treatment time without interruption. Conclusion: Conformal hypo fractionated radiotherapy is effective and well tolerated for patients with high grade glioma.
Highlights
Gliomas,3DCRT survival after surgery alone is approximately 4 months, indicating the need for more efficient and tolerable treatment alternatives (3)
Radiologic response: Follow up radiologic evaluation after four to six weeks of radiotherapy showed that two patients (6.7%) had complete response, twenty patients (66.7 %) had partial response, six patients (20 %) had stationary course and 2 patients (6.7%) had progressive course
Patients who underwent near resection showed one-year OAS and Progression Free Survival (PFS) rates of 100% and 50%, respectively, compared to 72% (( p =0.004,HR =0.195 and 95%CI = 0.064 – 0.596)), and 12% (p< 0.001, HR: 5.3, 95% CI: 2.4–11.5), multivariate Cox proportional hazard ratio regression analysis for potential independent predictors for Overall Survival (OAS) in this study showed that age and karnofsky performance status (KPS) are the most prognostic factors predicting overall survival where age ≤50 years has longer OS compared to age >50 years (p = 0.010, HR =0.148, 95%CI = 0.034 – 0.641) and KPS >70% has longer OS compared to>50 – 70%(p =0.015, HR = 0.078 and 95% CI=0.009 -0.603).This overall model fit: Chi-square = 18.352, d.f. =2, p
Summary
Gliomas,3DCRT survival after surgery alone is approximately 4 months, indicating the need for more efficient and tolerable treatment alternatives (3). Data from retrospective studies and prospective trials have shown that hypo fractionated radiation therapy delivering a slightly lower dose of radiation can achieve similar results in elderly patients or patients with poor performance status in comparison with the standard [6,7] week course of radiation therapy with or without chemotherapy Such shortened radiotherapy schedules would be beneficial for patients with limited life expectancy (8).with advent of highly précised radiotherapy as three dimensional conformal radiotherapy( (3DCRT) and intensity modulated radiotherapy(IMRT) planning and delivery has the general goal of conforming the shape of a target volume, and limiting dose to critical normal structures while increasing the tumor dose. This study evaluates the efficacy and safety of a conformal hypo fractionation scheme biologically near conventional fractionation
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