Multiple Daily Fractionated RT for Malignant Glioma

Yang, Kang Mo; Chang, Hye Sook; Ahn, Seoung Do; Choi, Eun Kyung

Abstract

Since Jan. 1992, authors have conducted a pilot study to treat malignant glioma with multiple daily fractionated (MDF) radiation therapy and this paper presents the outcome compared MDF to conventional fractionated (CF) radiation therapy. Between Sep. 1989 and Jan. 1993, forty-three patients with high grade glioma of brain except brain stem glioma were treated: nineteen patients were treated with CF radiation therapy and 24 patients were treated with MDF radiation therapy. In CF radiation therapy, total dose was 6300cHy/35fx in 7 weeks, which 5040cGy was delivered to the initial target volume and 1260cGy to reduced target volume. And in MDF radiation therapy, total dose was 6400cGy/40fx in 4 weeks, which 3200cGy was delivered to the initial target volume as 160cGy 2 times daily 6hr apart. All patients had histologically confirmed anaplastic astrocytoma (AA) of glioblastoma multiforme(GBM) with stereotactic biopsy or craniotomy for subtotal or gross tumor resection. The rage of follow-up was 7 months to 4 years with a median follow-up of 9 months. The Median survival from surgery was 9 months for all patients. The median survival was 9 months and 10 months for MDF group and CF group and 10 months and 9. 5 months for glioblastoma multiforme and anaplastic astrocytoma, respectively. In 36 patients with follow-up CT scan or MRI scan, disease status was evaluated according to treatment group. Four patients (GBM:3, AA:1) of 21 patients in MDF group, were alive with no evidence of disease, while none of patient was alive with no evidence of disease in CF group. The progression of disease had occurred in 20 patients, 11 patients and 9 patients in MDF group and CF group, espectively. All of these patients showed in-field progression of disease. Four of 11 patients (27%) in MDF group showed the new lesion outside of the treatment field, while 5 of 9 patients(56%) in CF group. In our study the prognosis was not influenced by age, KPS, grade, extent of surgery and different fractional scheduled radiation therapy. Authors concluded that MDF regimen was well tolerated and shortened the treatment period from 7 weeks to 4 weeks without compromising results. We believe that further follow-up is needed to assess the role of MDF.