title: Accelerated hyperfractionated radiotherapy for malignant gliomas.
abstract: OBJECTIVE
  To evaluate accelerated hyperfractionated radiotherapy for the treatment of malignant gliomas.
  
  
  METHODS
  Between April 1985 and June 1994, 70 adult patients with pathologically confirmed malignant glioma (75% glioblastoma multiforme, 25% anaplastic astrocytoma) suitable for high-dose therapy were selected for treatment with accelerated hyperfractionated radiotherapy, 1.5 Gy twice daily to a total target dose of 60 Gy. Two patients were excluded from analysis (one patient had a fatal pulmonary embolism after 18 Gy; one patient discontinued therapy after 28.5 Gy against medical advice and without sequelae or progression). The 68 patients in the study group had a median age of 52 years and a median Karnofsky performance status of 90. Stereotactic implant (125I) or stereotactic radiosurgery boosts were delivered to 16 patients (24%) in the study group. Minimum follow-up was 6 months.
  
  
  RESULTS
  Median survival was 13.8 months and median progression-free survival was 7.4 months. The absolute Kaplan-Meier survival rate was 16% at 2 years and 4% at 5 years. Multivariate analysis for the prognostic impact of age, gender, histology, Karnofsky performance status, symptomatology, surgical resection vs. biopsy, and boost vs. nonboost therapy revealed that Karnofsky performance status > or = 90, boost therapy, and surgical excision predicted significantly improved outcome. No severe toxicity occurred in patients treated with accelerated hyperfractionated radiotherapy alone, although 5% required steroids temporarily for edema. Progression occurred during treatment in one patient (1.5%).
  
  
  CONCLUSIONS
  This regimen of accelerated hyperfractionated radiotherapy is well tolerated and leads to results comparable with those of standard therapy. The rate of disease progression during treatment is significantly better (p = 0.001) than is reported for patients treated with standard fractionation, with or without chemotherapy. This regimen is a reasonable starting point for future trials and may have some advantages over standard fractionation.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida 32610-0385, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Buatti
authors.forename: R B
authors.initials: RB
authors.lastname: Marcus
authors.forename: W M
authors.initials: WM
authors.lastname: Mendenhall
authors.forename: W A
authors.initials: WA
authors.lastname: Friedman
authors.forename: F J
authors.initials: FJ
authors.lastname: Bova
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001929:Brain Edema / Q000209:etiology; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012086:Reoperation