Conformal Hypofractionated Radiotherapy Concomitant with and Followed By Temozolomide in High Grade Glioma in Elderly Patients

Purpose: To evaluate the efficacy and toxicity of conformal hypofractionated radiotherapy concomitant with and followed by adjuvant temozolomide in elderly patients with high grade glioma.Method: A total of thirty patients with high grade glioma were enrolled. All patients were treated with three dimentional (3D) conformal hypofractionated radiotherapy at a dose of 45 Gy/15 treatments over 3 weeks concomitant with TMZ at a daily dose of 75 mg/m² followed by adjuvant 6 cycles of TMZ at a dose of 200 mg/m² every 28 days.Results: The median age was 73 years (range 70-79). Four (13.33%) patients achieved complete response (CR) and 5 (16.66%) patients had partial response (PR). The median overall survival and progression free survival were 11 and 10 months respectively. The median follow-up time was 20 months (range 4-42).On univariat analysis of the prognostic factors, the extent of surgical resection and KPS were found to have significant impact on the survival (p=0.002 and 0.001 respectively). On multivariate cox regression analysis, KPS was the only significant prognostic independent factor (p=0.005).Acute grade 3 toxicity of concurrent chemoradiation included, grade 3 haematological toxicity in3 (10%), grade 1 radiation dermatitis and grade 2 headache in10% and 26% respectively. Chronic toxicity included, confusion in 7 (23%) patients, memory loss in 3 (10%), expression dysphasia in 3 (6.6%) and Focal leukoencephalopathy in 2 patients.Conclusion: Conformal hypofractionated radiotherapy concomitant with and followed by adjuvant TMZ is effective treatment for elderly patients with high grade glioma with acceptable and manageable toxicity especially in those with good performance status.