ACCELERATED HYPERFRACTIONATED RADIATION-THERAPY FOR MALIGNANT GLIOMA - A PHASE-II STUDY

Sixty-four adult patients with malignant glioma entered into a Phase I I study on the use of accelerated hyperfractionated radiation therapy, Histology included anaplastic astrocytoma (AA) in 15 patients and gli oblastoma multiforme (GEM) in 49 patients. Treatment consisted of radi ation therapy doses of 66 Gy in 44 fractions in 22 treatment days in 4 .5 weeks, fractions of 1.5 Gy, b.i.d. 1,3-bis(2-chlorethyl)-1-nitrosou rea (BCNU) 80 mg/m(2) and hydroxyurea 800 mg/m(2) were both given on t reatment days 1, 6, 11, 16, and 21 during the irradiation course. Medi an survival time for all 64 patients is 61 weeks (range: 12-163 weeks) from the date of starting irradiation, Median time to tumor progressi on (MTP) for GEM patients is 31 weeks, and 1-year and 3-year progressi on-free survival (PFS) are 16% and 0%, respectively, while MTP for AA patients is not attained yet, and 1-year and 3-year PFS are 100% and 7 3%, respectively. On univariate analysis of prognostic factors for GEM patients, younger age, total or subtotal tumor removal, and frontal t umor location are associated with a better prognosis. A multivariate a nalysis confirmed the importance of the extent of surgery and tumor si te and revealed the interfraction interval (4.5-5.0 hours vs 5.5-6.0 h ours, p =.041) as an important prognostic factor. Acute and late toxic ity is not increased. Longer follow-up and more patients are needed to evaluate tumor control and toxicity in AA patients.