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Hypofractionated radiation therapy and concurrent cisplatin in malignant cerebral gliomas. Rapid palliation in low performance status patients
Author(s) -
Hercbergs Aleck A.,
Tadmor Rina,
Findler Gidon,
Sahar Abraham,
Brenner Harold
Publication year - 1989
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19890815)64:4<816::aid-cncr2820640409>3.0.co;2-q
Subject(s) - medicine , hyperfractionation , concomitant , radiation therapy , nuclear medicine , performance status , cisplatin , glioma , chemotherapy , surgery , dose fractionation , cancer research
Twenty‐eight patients with high‐grade cerebral gliomas (16 biopsy‐proven and 12 diagnosed clinically and by computed tomography scan) were treated with altered fraction radiation and concomitant cisplatin (C‐DDP). Twenty cases (Groups IA and IB) whose Karnofsky performance status (KPS) was 60% or less received hypofractionation and C‐DDP. All these patients had received high‐dose Decadron (Merck Sharp & Dohme, West Point, PA), and their conditions were not improving or progressively deteriorating. The first 11 patients (Group IA) received from 600 CGY twice weekly to 3600 CGY over 3 weeks combined with C‐DDP IV at 40 mg/M 2 every 2 weeks for two courses. The nine subsequent patients (Group IB) received from 600 CGY weekly to 3600 CGY over 5 to 6 weeks with C‐DDP IV at 40 mg/M 2 every 1 to 2 weeks for four courses. The target volume in all cases was confined to the tumor as defined on computed tomography (CT) scan with a 2 cm to 3 cm margin. The C‐DDP at 40 mg/M 2 was administered immediately (within 5 minutes after radiation). Eight cases (Group II) with a KPS of more than 60% were treated with hyperfractionation, i.e. , from 200 CGY twice daily to 4800 CGY in just under 3 weeks. The C‐DDP was administered every 2 weeks for a total of two courses, as for Group IA. In Group I, 15 of 20 (75%) patients experienced rapid improvement in their performance status, which usually becoming evident within 1 to 2 weeks from the initiation of treatment, and progressed over time. Four patients with a KPS of 10% improved their KPS to over 60%. This regimen was both well tolerated and logistically very convenient both for the patients and attending staff. Follow‐up CT scans in three of 16 evaluable patients in the hypofractionated group showed complete tumor resolution. Median survival for Group IA was 7 months, for Group IB was 12 months, and overall was eight months. The Group II median survival was 9 months. This experience suggests that hypofractionated radiation in combination with C‐DDP may offer rapid palliation with improvement in functional status in severely compromised patients with malignant glioma.