IMRT and temozolomide for grade III glioma: Clinical and prognostic factors

Abstract

Background: To evaluate grade III gliomas treated in the era of IMRT and concurrent plus adjuvant Temozolomide (TMZ) with early clinical outcome and prognostic factors with quality of life. Methods: 53 patients with anaplastic oligodendroglioma(25), anaplastic astrocytoma (18) and anaplastic oligoastrocytoma(10) treated with IMRT and concurrent (95%) and adjuvant TMZ (90%) were analyzed. 1p19q co-deletion data was available for 13 patients. 80% had KPS at least 90 with 30% seizure at presentation. Postoperative MRI was available in 65% cases and IMRT dose was 60 Gy in 30 fractions. First post treatment imaging was performed at 1 month and then at 3 months and 6 months post IMRT and then every 3 months. EORTC quality of life scale C35 and BN 20 was administered before starting IMRT, at completion and then at each follow up. Kaplan-Meier analysis was used to estimate disease free survival (DFS), overall survival (OS) and analysis was done using SPSS version 18.0 Results: The median follow-up was 25 months with 2 year DFS and OS were 75% and 88%. Patients tolerated treatment well with only 5% symptomatic CNS and 8% symptomatic hematological toxicities. 95% completed concurrent TMZ schedule. At 1st evaluation, 30.4% had complete response, at 3 months 40% and at 6 months 43%. At 6 months only 4 % had progressive disease. Llast follow up 46/53 patients were evaluable with 8 deaths and 55% having stable to complete response. On univariate analysis for DFS, KPS at presentation > 90 (p = 0.001) and response at 6 months (p = 0.02) were significant and for OS KPS at presentation (p = 0.004) alone. Gross total resection, no residual at postoperative MRI, upto 6 cycles of adjuvant TMZ, complete response at 6 months were favorable in terms of both DFS and OS. Histopathological types were not significant for DFS and OS and only 3 patients were 1p19q co-deletion positive. Quality of life scales suggested decline in mood, cognition, fatigue and toilet control initially and improvement beyond 3 months. There were no significant late effects till last follow up. Conclusions: IIMRT with TMZ among grade III glioma patients resulted in minimum treatment related toxicities and better quality of life with encouraging results. Proper case selection with future molecular prognostic markers will determine most favorable groups.