P01.096 Hypofractionated radiotherapy and temozolomide in patients with glioblastoma and poor prognostic factors other than age - is it worth it?. (19th September 2018)

• Record Type: Journal Article
• Authors: Jablonska, P A; Gimeno, M; García-Consuegra, A; Arbea, L; Moreno, M; Azcona, D; Barbés, B; Ramos, L; Aramendía, J M; Gúrpide, A; Guridi, J; Díez Valle, R; Tomás-Biosca, A; Domínguez, P; Arbizu, J; Idoate, M A; Aristu, J J
• Is Part Of: Neuro-oncology. Volume 20(2018)Supplement 3
• Page Start: iii253
• Page End: iii253
• Publication Date: 2018-09-19
• Subjects: Brain Neoplasms -- Periodicals; Brain -- Tumors -- Periodicals; Brain -- Cancer -- Periodicals; Nervous system -- Cancer -- Periodicals; 616.99481
• DOI: 10.1093/neuonc/noy139.138
• Languages: English
• ISSNs: 1522-8517

Abstract

Abstract: Background: The impact of hypofractionated radiation therapy (HFRT) in elderly glioblastoma patients has recently been investigated, aiming to reduce the overall treatment time in this poor-prognosis group. There is evidence supporting that HFRT is comparable to conventional radiotherapy in terms of outcome and safety. The purpose of our study was to determine whether HFRT was satisfying in regard to disease control and feasibility in primary glioblastoma patients with other poor prognostic factors, such as high tumor burden, unresectability and/or low KPS. Material and Methods: Inclusion criteria were defined based on tumor and surgery-related characteristics, KPS/RPA score, patient's comorbidities, rapidly progressive disease and social or family factors that could influence the treatment adherence. Patients with KPS lower than 50% and brain stem tumors were excluded. Radiation treatment planning involved image fusion with brain CT-scan, MRI and 11C-Methionine PET. GTV included the surgical cavity plus macroscopic disease visible in T1WI MRI, Flair-MRI and the PET MET-uptake. Fourty grays were prescribed to 95% of PTV, in 15 fractions. Treatment was delivered using IMRT or VMAT techniques. Simultaneously, 75mg/m2/day of temozolomide were administered. Results: Between January 2010 and November 2017, 17 patients were enrolled. MGMT-methylation status was negative in 5 patients and 8 tumors were IDH wild type . The median KPS at diagnosis was 70%, with a median age of 68-years. Median tumor volume was 26, 95cc with a median PTV volume of 321, 75cc. Biopsy was performed in 4 patients and 5 lesions underwent a subtotal resection. With a median follow up of 52 months, median OS was 7 months and the PFS was 60% at 6 months, 33% at 1-year and 13% at 2-years. Acute grade 2 toxicity was documented in 2 patients. One patient presented a symptomatic radionecrosis five months after the radiation therapy. Conclusion: Patients with poor clinical factors other than advanced age could be selected for HFRT and temozolomide. The OS and PFS rates observed in our series are similar to the results obtained in patients treated with standard fractionation. HFRT is an option that assures good treatment adherence, low rates of toxicity and probably improves the cost-effectiveness. These data should be tested in a larger prospective trial.