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Abstract
Introduction. The article presents the final results of a study of two fractionation regimens for grade 4 gliomas.
Materials and Methods. A total of 140 patients had morphologically confirmed grade 4 glioma. In patients younger than 50 years and in the older age group (≥ 50 years), fractionation with a prescribed dose of 2 and 3 Gy was used alternately. As a result, thanks to the pairwise selection strategy, 23 patients younger than 50 years and 47 patients older than 50 years were recruited in the groups with two fractionation regimens, respectively.
Results. In the group with the fractionation regime of 2 Gy, a fatal outcome was recorded in 61 out of 70 patients (87.1 %), of the 52 patients with the fractionation regime of 3 Gy, 70 (74.3 %) died. In the group with the prescribed dose of 3 Gy, the median overall survival was 22.34 months (95 % Cl: 12.4-32.3), with the standard fractionation regimen (2 Gy) — 18.50 months (p = 0.039). Hypofractional regimen with a prescribed dose of 3 Gy was more effective in patients with grade 4 glioma over the age of 45 years (p = 0.007), with methylation of the MGMT promoter (p = 0.0009), and the absence of rapid early progression (REP) between microsurgery and radiation therapy (p = 0.014). The median overall survival for the hypofractionation regimen with a dose of 3 Gy in the «NonREP» group aged ≥ 45 years was 42.32 months (95 % CL: 25.7-58.9), with standard fractionation (2 Gy) — 19.68 months (95 % CL: 8.5-30.8; p = 0.005). In the remaining 76 patients there were no differences in survival depending on the fractionation regime, the median was 18.82 and 17.21 months in the 3/2 Gy groups, respectively (p = 0.793).
Conclusion. The hypo fraction regimen with a prescribed dose of 3 Gy is not inferior to the standard radiation therapy program, and in some subgroups exceeds it.
References
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