Clinical analysis of concurrent chemo-radiotherapy combined with adjuvant chemotherapy after surgical resection in patients with high-grade glioma

Objective: To investigate the efficacy and safety of concurrent chemo-radiotherapy [magnetic resonance imaging (MRI) simulation localization] combined with adjuvant chemotherapy after surgical resection in patients with high-grade glioma. Methods: Seventy-nine consecutive postoperative patients with grades Ⅲ-Ⅳ glioma received concurrent chemo-radiotherapy in Department of Radiation Oncology, Shanghai Minhang District Cancer Hospital between December 2004 and November 2009. The conformal radiation therapy was performed with a 6 MV X-ray fractionated-dose of 1.8-2.0 Gy and up to a total dose of 60 Gy in 30-33 fractions. The concurrent chemotherapy was administered with temozolomide at a dose of 75 mg/m2 per day until the end of radiation therapy. One month after radiotherapy, temozolomide was administered 150 mg/m2 per day for 5 days in the first cycle of adjuvant chemotherapy and 200 mg/m2 per day for 5 days in the following cycles and repeated every 21 days. The follow-up was conducted in 79 patients. The one-, two-, and three-year survival rates were calculated by Kaplan-Meier method. Results: The rate of follow-up was 100% with a median follow-up of 44 months (range: 12-60). The one-, two-, and three-year survival rates were 87.3%, 58.5% and 37.6%, respectively. The median survival time was 42 months. The result of COX proportional-hazards regression revealed that the age (≥ 48 years vs < 48 years, P = 0.027), pathological classification (grade Ⅲ vs grade Ⅳ, P = 0.023), cycles of chemotherapy with temozolomide after radiation (1-2 vs 3-6, P = 0.053), radiation dose (< 60 Gy vs 60 Gy, P = 0.008) and residual tumor after operation (yes vs no, P = 0.020) were independent prognostic factors. No severe adverse effects related to radiation therapy and chemotherapy were observed. Conclusion: The conformal radiation therapy using MRI simulation localization combined with concurrent chemotherapy and adjuvant chemotherapy after surgical resection in patients with high-grade glioma seems to have a favorable efficacy and tolerability. DOI:10.3781/j.issn.1000-7431.2014.04.010