Concurrent Hypofractionated Three-dimensional Re-irradiation and Temozolomide in Recurrent Malignant Glioma

Abstract

Background: This study determines the efficacy and tolerability of hypofraction- ated three-dimensional conformal radiotherapy in conjunction with daily temozolomide in treatment of previously irradiated recurrent malignant glioma.Methods:We enrolled 21 patients diagnosed with recurrent or progressive malignant glioma who previously underwent external beam irradiation. All patients had hypofrac- tionated three-dimensional conformal radiotherapy to a total dose of 30 Gy in six fractions, over a two-week period, concurrent with daily temozolomide (75 mg/m2).Results: At the median follow up of 9.5 months (range: 2.5-42), there were 18 (86%) patients who had died. Median overall survival from the onset of hypofractionated three- dimensional conformal radiotherapy was nine months and median time to progression was five months. There was no detectable severe toxicity. Salvage surgery prior to hypofractionated three-dimensional conformal radiotherapy and planning target volume significantly influenced patient outcome according to multivariate analysis.Conclusion: Hypofractionated conformal re-irradiation concurrent with daily temozolomide is a feasible, well-tolerated treatment for recurrent malignant glioma. Patients with surgical re-resection and smaller planning target volumes have the most favorable outcomes.