Objectives: To compare the radiological response in high grade glioma patients receiving post-operative radiation therapy via 3DCRT /IMRT technique with concurrent and adjuvant temozolomide.

Materials and Methods: Twenty newly diagnosed histologically proven patients of high grade glioma in the age group of 18-70 years, post maximal resection were recruited and all patients received concurrent chemo-irradiation followed by adjuvant chemotherapy. All patients received a dose of 60 Gy in 30 fractions via 3DCRT/IMRT technique along with concurrent and adjuvant temozolomide according to Stupp’s regimen. Radiological response was assessed using Cho:NAA ratio in magnetic resonance spectroscopy done at 0,4th and 14th week of radiation therapy.

Results: There was no statistically significant difference in the post radiation therapy radiological response with respect to Cho:NAA ratio between the 2 groups suggesting similar outcomes when high grade gliomas are treated with 3DCRT / IMRT technique.

Conclusion: In patients diagnosed with high grade glioma treated by post-operative radiation therapy with concurrent and adjuvant temozolomide, radiation therapy can be delivered either with 3DCRT or IMRT technique without compromise in radiological response to treatment.

Keywords: Intensity Modulated Radiation Therapy (IMRT), 3D Conformal Radiation Therapy (3DCRT), Temozolomide, MRS (Magnetic Resonance Spectroscopy), glioma.

1. Weller M. Novel diagnostic and therapeutic approaches to malignant glioma. Swiss Med Wkly.141:w13210
2. Brandes AA. State-of-the-art treatment of high-grade brain tumors. Semin Oncol. 2003 Dec; 30(6 Suppl 19):4-9.
3. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005 Mar 10; 352(10):987-96.
4. Bobek-Billewicz B, Stasik-Pres G, Majchrzak H, Zarudzki L. Differentiation between brain tumor recurrence and radiation injury using perfusion, diffusion-weighted imaging and MR spectroscopy. Folia Neuropathol Assoc Pol Neuropathol Med Res Cent Pol Acad Sci. 2010;48(2):81–92.
5. Nieder C andratschke N, Price RE, Rivera B, Ang KK. Innovative prevention strategies for radiation necrosis of the central nervous system. Anticancer Res. 2002 Apr;22(2A):1017–23.
6. Kumar AJ, Leeds NE, Fuller GN, Van Tassel P, Maor MH, Sawaya RE, et al. Malignant gliomas: MR imaging spectrum of radiation therapy and chemotherapy-induced necrosis of the brain after treatment. Radiology. 2000 Nov; 217(2):377–84.
7. Smith EA, Carlos RC, Junck LR, Tsien CI, Elias A, Sundgren PC. Developing a clinical decision model: MR spectroscopy to differentiate between recurrent tumor and radiation change in patients with new contrast-enhancing lesions. AJR Am J Roentgenol. 2009 Feb;192(2):W45–52.
8. Sabry A. Elmogy AEM. MR spectroscopy in post-treatment follows up of brain tumors. Egypt J Radiol Nucl Med. 2011;42(s 3–4):413–24.
9. Weybright P, Sundgren PC, Maly P, Hassan DG, Nan B, Rohrer S, et al. Differentiation between brain tumor recurrence and radiation injury using MR spectroscopy. AJR Am J Roentgenol. 2005 Dec;185(6):1471–6.
10. Schlemmer H-P, Bachert P, Herfarth KK, Zuna I, Debus J, Kaick G van. Proton MR Spectroscopic Evaluation of Suspicious Brain Lesions After Stereotactic Radiotherapy. Am J Neuroradiol. 2001 Aug 1;22(7):1316–24.
11. Schlemmer HP, Bachert P, Henze M, Buslei R, Herfarth KK, Debus J, et al. Differentiation of radiation necrosis from tumor progression using proton magnetic resonance spectroscopy. Neuroradiology. 2002 Mar;44(3):216–22.
12. Wen, P. Y., Macdonald, D. R., Reardon, D. A., Cloughesy, T. F., Sorensen, A. G., Galanis, E., ... Chang, S. M. (2010). Updated response assessment criteria for high-grade gliomas: Response assessment in neuro-oncology working group. Journal of Clinical Oncology, 28(11), 1963-1972. DOI: 10.1200/JCO.2009.26.3541
13. Magnetic Resonance Spectroscopy for Differentiating Pseudo-Progression from True Progression in GBM on Concurrent Chemoradiotherapy V. Sawlani, R. Taylor, K. Rowley, R. Redfern, J. Martin, H. Poptani
14. Kinoshita Y, Kajiwara H, Yokota A, Koga Y. Proton magnetic resonance spectroscopy of brain tumors: an in vitro study. Neurosurgery. 1994 Oct; 35(4):606–13; discussion 613–4.
15. Kuesel AC, Sutherland GR, Halliday W, Smith IC. 1H MRS of high grade astrocytomas: mobile lipid accumulation in necrotic tissue. NMR Biomed. 1994 May;7(3):149–55.
16. Urenjak J, Williams SR, Gadian DG, Noble M. Proton nuclear magnetic resonance spectroscopy unambiguously identifies different neural cell types. J Neurosci Off J Soc Neurosci. 1993 Mar;13(3):981–9.
17. Rabinov JD, Lee PL, Barker FG, Louis DN, Harsh GR, Cosgrove GR, et al. In vivo 3-T MR spectroscopy in the distinction of recurrent glioma versus radiation effects: initial experience. Radiology. 2002 Dec;225(3):871–9.
18. Kaminaga T, Shirai K. Radiation-induced brain metabolic changes in the acute and early delayed phase detected with quantitative proton magnetic resonance spectroscopy. J Comput Assist Tomogr. 2005 Jun;29(3):293–7.
19. MACDONALD, Shannon M et al. Intensity Modulated Radiation Therapy (IMRT) Versus Three Dimensional Conformal Radiation Therapy (3DCRT) for the Treatment of High Grade Glioma: A Dosimetric Comparison. Journal of Applied Clinical Medical Physics, [S.l.], v. 8, n. 2, apr. 2007. ISSN 15269914.
20. Chan MF, Schupak K, Burman C, et al. Comparison of intensity-modulated radiotherapy with three-dimensional conformal radiation therapy planning for glioblastoma multiforme. Med Dosim. 2003;28(4):261­265.

Dr Chaitanya S

Post-Graduate Student, Department of Radiation Oncology,

Kidwai Cancer Institute, Bengaluru-29

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