open access

Vol 25, No 6 (2020)
Original research articles
Published online: 2020-11-01
Submitted: 2020-01-24
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Hypofractionated radiation therapy with temozolomide versus standard chemoradiation in patients with glioblastoma multiforme (GBM): A prospective, single institution experience

Amal Rayan, Samya Abdel-Kareem, Huda Hasan, Asmaa M. Zahran, Doaa A. Gamal
DOI: 10.1016/j.rpor.2020.08.010
·
Rep Pract Oncol Radiother 2020;25(6):890-898.

open access

Vol 25, No 6 (2020)
Original research articles
Published online: 2020-11-01
Submitted: 2020-01-24

Abstract

Background and aim: the study aimed to determine whether hypofractionated radiotherapy (HFRT) with simultaneous and adjuvant temozolomide (TMZ) was feasible and could provide adequate disease control in primary GBM patients with poor prognostic factors including large tumor size, poor performance status, unresectable or multifocal lesions, poor imaging and inflammatory indices. Patients and methods: A total of 93 patients with glioblastoma multiforme were collected and distributed randomly as 1:1.7 of cases to controls; cases or arm (I) received HFRT with 45 Gy in 15 fractions over 3 weeks concurrently with TMZ. Controls or arm (II) received standard conventional fractionation radiotherapy of 60 Gy in 30 fractions over 6 weeks concurrently with TMZ. Results: 35 patients were recruited in arm I while 58 patients in arm II with significant difference in site of GBM, pattern of enhancement, type of surgery, and neutrophil to lymphocyte ratio, while no significant differences in tumor size, focality, responses, progression free survival, and overall survival (OS), only the type of surgery was an independent predictor for OS, no significant difference in the type and degree of toxicity between both arms. Conclusion: Our results showed that HFRT with concurrent TMZ is a feasible therapeutic approach in patients with GBM, especially those with poor prognostic factors, assuring high treatment compliance and low toxicity rates. Dose escalation and reduction in overall treatment time are clear advantages of HFRT, while at least the same survival rates as conventional fractionated RT are maintained.

Abstract

Background and aim: the study aimed to determine whether hypofractionated radiotherapy (HFRT) with simultaneous and adjuvant temozolomide (TMZ) was feasible and could provide adequate disease control in primary GBM patients with poor prognostic factors including large tumor size, poor performance status, unresectable or multifocal lesions, poor imaging and inflammatory indices. Patients and methods: A total of 93 patients with glioblastoma multiforme were collected and distributed randomly as 1:1.7 of cases to controls; cases or arm (I) received HFRT with 45 Gy in 15 fractions over 3 weeks concurrently with TMZ. Controls or arm (II) received standard conventional fractionation radiotherapy of 60 Gy in 30 fractions over 6 weeks concurrently with TMZ. Results: 35 patients were recruited in arm I while 58 patients in arm II with significant difference in site of GBM, pattern of enhancement, type of surgery, and neutrophil to lymphocyte ratio, while no significant differences in tumor size, focality, responses, progression free survival, and overall survival (OS), only the type of surgery was an independent predictor for OS, no significant difference in the type and degree of toxicity between both arms. Conclusion: Our results showed that HFRT with concurrent TMZ is a feasible therapeutic approach in patients with GBM, especially those with poor prognostic factors, assuring high treatment compliance and low toxicity rates. Dose escalation and reduction in overall treatment time are clear advantages of HFRT, while at least the same survival rates as conventional fractionated RT are maintained.

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Keywords

Glioblastoma multiforme; Hypofractionated radiotherapy; Temozolomide; Progression free survival; Overall survival

About this article
Title

Hypofractionated radiation therapy with temozolomide versus standard chemoradiation in patients with glioblastoma multiforme (GBM): A prospective, single institution experience

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 25, No 6 (2020)

Pages

890-898

Published online

2020-11-01

DOI

10.1016/j.rpor.2020.08.010

Bibliographic record

Rep Pract Oncol Radiother 2020;25(6):890-898.

Keywords

Glioblastoma multiforme
Hypofractionated radiotherapy
Temozolomide
Progression free survival
Overall survival

Authors

Amal Rayan
Samya Abdel-Kareem
Huda Hasan
Asmaa M. Zahran
Doaa A. Gamal

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