South Clin Ist Euras. 2019; 30(3): 222-227 | DOI: 10.14744/scie.2019.78941

Hypofractionated Radiation Therapy with Temozolomide for Patients with Glioblastoma Multiforme Recursive Partitioning Analyzes Class V and VI

Fuzuli Tuðrul¹, Gokhan Yaprak², Atilla Arslankaya¹, Naciye Iþýk^2
1Department of Radiation Oncology, Yunus Emre State Hospital, Eskiþehir, Turkey
²Department of Radiation Oncology, University of Health Sciences, Kartal Dr. Lütfi Kýrdar Training and Research Hospital, Ýstanbul, Turkey

INTRODUCTION: This study was performed to determine whether adjuvant temozolomide and 45 Gy/15 fr hypofractionated radiotherapy (RT) can be used to shorten the treatment duration in glioblastoma multiforme (GBM) patients with poor prognostic factors (Recursive Partitioning Analyzes (RPA) categories V, VI), without increasing the dose and toxicity and without risking the survival.
METHODS: Patients older than 50 years, with histological diagnosis of GBM, who were in either RPA class V or VI were included in this retrospective single-arm single-center study. Patients were treated with a tumor dose of 45 Gy in 15 daily fractions in 15 treatment days in three weeks, together with concomitant temozolomide and adjuvant temozolomide.
RESULTS: A total of 43 patients were included in this study. RT was completed as planned in full dose in all patients. No grade 3 acute toxicity due to hypofractionated RT was observed. Concomitant temozolomide was also used in all patients without dose lowering while adjuvant temozolomide as six cycles was applied in 27 patients, but in 12 of them, temozolomide dose was lowered due to hematological toxicity. Median overall survival was found as 10.5 months, and 1-year overall survival proportion was 42%. The median progression-free survival time was 8.4 months.
DISCUSSION AND CONCLUSION: While no decrease in expected survival with hypofractionated radiotherapy and temozolomide was detected, no increase in toxicity was observed.

Keywords: Glioblastoma multiforme, hypofraction; radiation therapy; temozolomide.

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RPA Skoru V ve VI Olan Glioblastom Hastalarýnda Temazolamidle Hipofraksiyone Radyoterapi

Fuzuli Tuðrul¹, Gokhan Yaprak², Atilla Arslankaya¹, Naciye Iþýk^2
1Yunus Emre Devlet Hastanesi Radyasyon Onkolojisi Kliniði, Eskiþehir
²Saðlýk Bilimleri Üiversitesi Kartal Dr Lütfi Kýrdar Eðitim ve Araþtýrma Hastanesi Radyasyon Onkolojisi Kliniði, Ýstanbul

GÝRÝÞ ve AMAÇ: Bu çalýþma, kötü prognostik faktörlere (Recursive Partitioning Analyzes -RPA- skor V, VI) sahip glioblastome multiforme (GBM) hastalarýnda dozu ve toksisiteyi arttýrmadan ve saðkalýmý azaltmadan, adjuvan temozolamid ve 45 Gy/15 fr hipofraksiyone radyoterapi (RT) rejiminin, tedavi süresini kýsaltmak için kullanýlýp kullanýlamayacaðýný belirlemek için yapýldý.
YÖNTEM ve GEREÇLER: Bu geriye dönük tek kollu ve tek merkezli çalýþmaya; 50 yaþýndan büyük GBM histolojik tanýlý, RPA skoru V veya VI olan hastalar dahil edildi. Hastalara, üç haftada 15 fraksiyonda 45 Gy RT, eþzamanlý temozolamid ile birlikte uygulandý. Radyoterapi sonrasý adjuvan temozolamid ile tedaviye devam edildi.
BULGULAR: Çalýþmaya toplam 43 hasta alýndý. Tüm hastalar planlanan dozda RT’yi tamamladý. Hipofraksiyone RT nedeniyle grade 3 akut toksisite gözlenmedi. Eþzamanlý temazolamid bütün hastalarda doz azaltýlmaksýzýn uygulandý. Akabinde altý kür adjuvan temozolamid alan 27 hastanýn 12’sinde geliþen hematolojik toksisite nedeniyle doz azaltýlmasýna gidildi. Ortanca genel saðkalým 10.5 ay ve bir yýllýk genel saðkalým oraný %42 idi. Ortanca progresyonsuz saðkalým süresi 8.4 aydý.
TARTIÞMA ve SONUÇ: Hipofraksiyone radyoterapi ve eþzamanlý temozolamid ile saðkalýmda bir azalma gözlenmezken, toksisitedede bir artýþ izlenmedi.

Anahtar Kelimeler: Glioblastoma multiforme, hipofraksiyanasyon; radyoterapi; temozalamid.

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