Hypofractionated Radiotherapy with Temozolamide in Glioblastoma Multiforme

INTRODUCTION: GBM accounts for approximately 75% of all high-grade gliomas.The standard treatment regimen is surgery followed by post-operative radiotherapy 60 Gy in 2 Gy /# given in 30 # along with temozolamide. Hypofractionated radiotherapy with reduced treatment time is considered to be an acceptable alternate form of treating elderly and poor prognosis younger patients. AIM OF THE STUDY: To evaluate the safety and efficacy of hypofractionated radiotherapy in RPA class 4, 5 and 6 glioblastoma patients and to assess quality of life after the end of treatment. The secondary objective is to assess response rate and survival. MATERIALS AND METHODS: Single arm prospective study with 30 patients diagnosed with glioblastomapresented to the department of radiation oncology,madras medical college, Chennai. Patients diagnosed with glioblastomamultiforme with age 50 and KPS >70 are treated with phase 1: 30 Gy/3 Gy /# in 10# and boost of 7#/3 Gy/# to tumour and a margin of 1.5 cm to a total of 51Gy to the tumour along with concurrent administration of temozolamide and advuvanttemozolamide in 6 cycles. Toxicity of the treatment with RTOG and FACT-Br scale with quality oflife at the end of the treatment period is noted. RESULTS: Among 30 patients, 24 are men and 6 are women.Median age is 56 years. There is no deterioration in the quality of life at the end of the treatment period in any of the patients treated. CNS late toxicity grade 1observed in 9 patients, grade 2 in 5 patients and grade 3 in 6 patients. No grade 4 or treatment related deaths in this study. Partial response is observed in 12 patients and stable response in 16 patients. CONCLUSION: Hypofractionated radiotherapy with temozolamide can be considered as an acceptable alternate fractionated therapy protocol in selected group ofglioblastoma patients with acceptable toxicity