title: Hyperfractionated radiation therapy for incompletely resected supratentorial low-grade glioma: a 10-year update of a phase II study.
abstract: OBJECTIVE
  To provide a 10-year update of hyperfractionated radiation therapy (Hfx RT) in adults with incompletely resected supratentorial low-grade glioma.
  
  
  METHODS
  A total of 37 patients were treated with 55 Gy in 50 fractions in 25 treatment days in 5 weeks to tumor plus 2 cm, and additional 17.6 Gy given in 16 fractions in 8 treatment days in 1.5 weeks to tumor plus 1 cm, (1.1 Gy twice daily). Total dose was 72.6 Gy in 66 fractions in 33 treatment days in 6.5 weeks.
  
  
  RESULTS
  After a median follow-up time of 121 months for all patients, the median survival time (MST) for all 37 patients was 145 months, whereas 10-year survival rate was 67%. Median time to tumor progression (MTP) has not yet been attained, but 10-year progression-free survival (PFS) rate was 62%. There was no difference in survival or PFS regarding gender, age, location, site, size, CT enhancement, and histology; whereas lower KPS, higher neurologic status, and lesser extent of surgery had an adverse influence. Infield progression occurred in 15 (88%), whereas in only 2 (12%) patients, tumor progression was described as marginal. Brain necrosis has not been observed so far. Autopsy findings confirmed recurrent glioma and excluded post-RT necrosis in 14 (38%) patients. Of those, 7 (50%) patients had either Grade 3 (n = 4) or Grade 4 (n = 3) glioma.
  
  
  CONCLUSIONS
  High-dose HFX RT is effective with mild to moderate toxicity. Further studies are warranted with more patients before testing it against standard fractionation RT in this patient population.
authors.affiliation: Department of Oncology, University Hospital, Kragujevac, Belgrade, Yugoslavia. bjeremic@lrz.tu-muenchen.de
authors.forename: Branislav
authors.initials: B
authors.lastname: Jeremic
authors.forename: Biljana
authors.initials: B
authors.lastname: Milicic
authors.forename: Danica
authors.initials: D
authors.lastname: Grujicic
authors.forename: Miroslav
authors.initials: M
authors.lastname: Samardzic
authors.forename: Vaso
authors.initials: V
authors.lastname: Antunovic
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Dagovic
authors.forename: Jasna
authors.initials: J
authors.lastname: Aleksandrovic
authors.forename: Miroslav
authors.initials: M
authors.lastname: Stojanovic
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015173:Supratentorial Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D015996:Survival Rate