Survival outcome and neurotoxicity in patients of high-grade gliomas treated with conformal radiation and temozolamide
Anil Kumar Anand1, Amal Roy Chaudhory1, Har Narain Aggarwal2, Pushpender Kumar Sachdeva3, Pritam Singh Negi1, Sujit Nath Sinha1, Ananda Giri Babu1, Amarnath Jena4, Avinash Rao5, Partha S Chaudhury6
1 Department of Radiation Oncology, Ganga Ram Hospital, Delhi, India
2 Department of Neurosurgery, Ganga Ram Hospital, Delhi, India
3 Department of 2Neuro Surgery, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
4 Department of MRI, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
5 Department of Imaging, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
6 Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
Anil Kumar Anand
Department of Radiation Oncology, Max Cancer Centre, Max Hospital, 2, Press Enclave Road, Saket, New Delhi-110017
Source of Support: None, Conflict of Interest: None
Background: To study the survival outcome and neurotoxicity grades in patients of high-grade glioma (HGG) treated with conformal radiation and temozolamide.
Materials and Methods: Forty-six patients of HGG received conformal post operative radiation and temozolamide in the period 2003 to 2007. Twenty seven patients had near total resection, 17 had subtotal resection and 2 had biopsy only. 33 patients (71.7%) were treated with IMRT and 13 (28.3%) received 3DCRT (conformal radiation). Median dose delivered to PTV2 was 61.58Gy and PTV1 was 54.3Gy. Neurotoxicity was assessed with sequential MRI and cognitive disturbance was evaluated and grading was done according to CTCAE version 2.0 and 3.0 respectively.
Results: At a median follow-up of 12 months, median progression free and overall survival was 9 months and 15 months respectively. At 6 months, MRI neurotoxicity of grade 1, 2, and 3 was seen in 34.3, 11.4 and 2.9% patients. At 24 months, 35.3 and 29.4% patients had grade 1 and 2 neurotoxicity respectively. Cognitive disturbance was grade 0, 1, 2 and 3 in 55, 34.4, 6.8 and 3.4% patients at 6 months and grade 0 and grade 1 in 51.1 and 42.8% patients respectively at 24 months.
Conclusion: Conformal Radiation yields low grades of MRI assessed neurotoxicity and cognitive disturbance in patients of HGG with no adverse impact on local control and survival.