Late Radiation Outcomes of Patients with Newly Diagnosed Glioblastoma Treated with Accelerated Hyperfractionated Radiotherapy and Temozolomide

Abstract

This study aimed to evaluate the late radiation outcomes in patients with glioblastoma who were treatedwith accelerated hyperfractionated radiotherapy (AHRT) and concurrent plus adjuvant temozolomide(TMZ).METHODSBetween 2006 and 2007, 32 consecutive patients with glioblastoma were treated with AHRT and TMZ.The total dose of 66 Gy was administered in 33 fractions within 6 weeks. In phase I, PTV1 received 40Gy (2 Gy per fraction, five times per week). In phase II, 26 Gy was delivered to PTV2 by adding a seconddaily fraction at intervals of 8 hours once every 3 days. All patients received chemotherapy according tothe Stupp protocol. Toxicities were evaluated based on the CTCAE v3.0.RESULTSThe median follow-up period was 18 months. A total of 28 patients completed the planned radiotherapy schedule, and 20 patients received six cycles of adjuvant TMZ. Median overall survival (OS) andprogression-free survival (PFS) were 17 and 10 months, respectively. In univariate analysis, age, performance status, and RPA classes III–IV were found significant for OS. Multivariate analysis showed thatsix cycles of TMZ administration affected both OS and PFS. Late grade-4 central nervous system (CNS)toxicities were observed in five patients.CONCLUSIONIt was observed that it is both feasible and effective to administer AHRT with TMZ in a selected group ofpatients. It provides better short-term survival advantage than the standard treatment regimen.