RESUMO
Brain stem tumors are special challenge because primarily of their location and the neurologic effect caused by these groups of tumors [Paul 1997]. Radiation therapy improves survival for brain stem tumors and stabilizes or reverses neurologic dysfunction in 75-90% of patients. The main domain of applicability of hyperfractionation would be in tumor sites where the dose limiting tissue is late reacting and whose effective control requires the delivery of doses beyond tolerance [Awwad, 1990], hence the rationale for the use of hyperfractionation in brain stem lesions. The purpose of this work is to find out the best radiation protocol in this group of patients comparing conventional fractionation and hyperafractionation. This study included 46 patients which brainstem tumors treated in Radiation Oncology and Neurosurgery Departments Ain Shams University between February 1998 and May 2000. These patients had been randomly distributed in 2 groups A and B. The first group treated by conventional radiotherapy protocol and the second group treated by hyperfractionation radiation protocol. By the end of the study, the median over all survival and median time for disease progression were calculated for each group. Age, neurologic status at presentation and anatomical location were significant prognostic factors. By the end of this study clicinal evalualion had no significant difference between both groups but the median over all survival for the two groups was 10.5 months, the median survival for group A was 9.4 months and that for group B was 11.5 months which was statistically significant P < 0.02. On the other hand the percentage of patient with one year survival for group A and B [22%, 32%] respectively. The rate of acute [early] reaction of radiation is slightly higher in hyperfracticmaticm than conventional fractionation but the late reactions occur with same frequency with both regimens