Accelerated fractionation radiotherapy for hospitalized glioblastoma multiforme patients with poor prognostic factors

The standard 6 week course of post-operative radiotherapy for glioblastoma multiforme (astrocytoma grade IV) is lengthy, considering the poor prognosis. The standard schedule is especially unsuitable for hospitalized patients and for those with poor prognostic factors (such as old age and poor performance status) since their survival is particularly short. In order to improve the survival-treatment time ratio, we entered a total of 14 hospitalized patients with glioblastoma multiforme (GBM) and poor prognostic factors (mean age 62, mean KPS 57%) into a Phase I trial of accelerated fractionation (AF) external beam radiotherapy. A total tumor dose of 5400-5500 cGy was given in 3 weeks: 4300-4500 cGy whole brain using 100 cGy tid fractions on weekdays plus a 900-1200 cGy boost using single daily fractions of 150-200 cGy on weekends. Only one patient entered did not complete therapy, due to the development of pulmonary embolism resulting in death. Mean survival for all 14 patients from the time of surgical diagnosis was 30.4 weeks. The schedule was well tolerated and resulted in a substantial decrease in treatment time compared to conventional fractionation in these patients. AF schedules should continue to be explored since they may be more appropriate than conventional fractionation schedules for GBM patients with poor prognostic factors, particularly when hospitalized.