Outcome of high grade gliomas–An institutional experience

Objective: In this study we evaluated the prognostic factors, dosimetry and survival outcome of high grade gliomas receiving radiotherapy with concurrent temozolomide and with or without adjuvant temozolomide. Materials and Methods: Eighty patients with high grade gliomas were treated with concurrent chemoradiation post operatively. 27 patients received 3D Conformal Radiotherapy, 25 received Intensity Modulated Radiotherapy and 28 were treated with Rapid arc. Temozolomide 75mg/m2/d seven days a week was given concurrently with radiation (60Gy in 30 fractions) followed by 6 cycles of adjuvant Temozolomide with a dose of 150mg/m2/d for 5 days in every 28 days. Primary end point was overall survival and secondary end point was effect of radiation technique on overall survival and dose to organs at risk. Results: All patients completed concurrent chemoradiation but only 52 patients completed 6 months course of adjuvant chemotherapy. Median age was 52.5 years; The prognostic factors important for overall survival are at least 6 cycles of adjuvant temozolomide (p<0.0001) and mean dose to normal brain <30 Gy (p-0.022). Median overall survival was 6 months. The median survival for patients who completed 6 months of adjuvant chemotherapy and those who did not was 12 months and 3 months respectively. Survival at 12, 18 and 24 months were 24.5%, 13.2% and 11.3% respectively for patients treated with high precision radiotherapy. One year survival in 3DCRT group was 3.7%. Mean dose to normal brain was 28.7Gy in 3DCRT, 23.9Gy in high precision technique respectively. Conclusion: Reduced doses to normal brain with high precision techniques and improved survival in our patients receiving radiotherapy with concurrent temozolomide & adjuvant 6 cycles of temozolomide.