2172 - Tile-Based Radiation Therapy for Upfront Treatment of Grade 4 Gliomas in Patients =70 Years and/or Low KPS: Prospective Multi-Institutional Outcomes
Presenter(s)
C. Burns1, J. Glass2, L. Sloan3, A. W. Nowlan4, C. Chen5, A. Richardson6, S. Hanft7, J. Wanebo8, J. Beecher9, C. Shen10, S. Patel11, M. S. Peach12, and D. W. Kim13; 1Virginia Tech Carilion School of Medicine, Roanoke, VA, United States, 2Brody School of Medicine, East Carolina University, Greenville, NC, 3University of Minnesota: Department of Radiation Oncology, Minneapolis, MN, 4Peachtree Radiation Oncology, Atlanta, GA, 5Department of Neurosurgery at the Warren Alpert Medical School of Brown University, Providence, RI, 6Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, 7Westchester Medical Center, Valhalla, NY, 8Ivy Brain Tumor Center, Barrow Neurological Institute, Phoenix, AZ, 9Atlantic Brain and Spine, Wilmington, NC, 10Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, 11GT Medical Technologies, Phoenix, AZ, United States, 12Department of Radiation Oncology, Brody School of Medicine, East Carolina University, Greenville, NC, 13Inova Health System, Fairfax, VA
Purpose/Objective(s): Operable glioblastoma patients aged =70 and/or with Karnofsky Performance Status (KPS) <60 are commonly treated with hypofractionated external beam radiotherapy to reduce treatment burden. We hypothesized that upfront tile-based radiation therapy (TBRT) with cesium-131 brachytherapy immediately initiating radiation at the time of resection provides durable survival while preserving quality of life (QOL) and functional status in this population
Materials/Methods:
Clinical data was prospectively collected from 21 consecutive patients with newly diagnosed glioblastoma aged =70 and/or KPS <60 undergoing craniotomy with TBRT across 10 institutions. KPS was recorded pre op, immediately post op, and at 1, 3, 6, 9, and 12 months. QOL was assessed using the Linear Analogue Self-Assessment (LASA) at corresponding time points. Median overall survival (mOS) was calculated from TBRT implantation and stratified by MGMT status, temozolomide use, and extent of resection.Results:
Median follow-up was 11.97 months. Eleven patients were male and nine female. Two patients were <70 with KPS <60. Among the nineteen remaining >70 year old cohort, one had KPS =60. Gross total resection (GTR) was achieved in 15 patients, near-GTR (>90%) in 4 patients, and subtotal resection (25-90%) in two patients. Median tumor diameter was 4.8 cm (range 2.4–9.0 cm), most commonly frontal (45%) or temporal (35%). A median of 8 tiles (range 3–16) were implanted in a median of 4 minutes (range 2.4-9). In the first 30 postoperative days (POD), 2/21 patients had adverse events =Gr 3: cerebral edema (POD 2/Gr 5; possible surgery/TBRT-related); and SMA syndrome (POD 1/Gr 4; definite surgery, possible TBRT-related), dysphagia (POD 2/Gr 3; probable surgery-related), ARDS (POD 4/Gr 4; definite surgery-related), and aspiration pneumonia (POD 4/Gr 3; possible surgery-related). Mean baseline KPS was 73.2 and remained stable at 0, 1, 6, and 12 months post op (73.6, 73.8, 76.4 and 71.7, respectively). Mean LASA improved from 6.85 at baseline to 7.82 at 3 months and remained above baseline at 6 and 12 months (7.02 and 7.74). mOS for the full cohort was 14.01 months. Survival was not significantly affected by MGMT methylation status, use of temozolomide or resection extent. Excluding patients <70 years with low KPS yielded the same mOS.Conclusion: In this prospective multi-institutional cohort of elderly and/or low-KPS patients, upfront TBRT demonstrated mOS exceeding historical expectations while maintaining functional status and QOL, with a low incidence of early high-grade toxicities. Treatment was delivered intraoperatively without prolonged radiation schedules, minimizing treatment burden. TBRT should be considered a viable frontline radiotherapeutic strategy for operable glioblastoma patients aged =70 and/or with poor performance status.