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

Background: This study determines the efficacy and tolerability of hypofractionated 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 hypofractionated 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 threedimensional 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.