Title: High Grade Asrtocytomas Whole Brain Radiotherapy (WBRT) vs Limited Volume Brain Radiotherapy (LVBRT)- A Prospective Randomized Study
Authors: Dr C.S.K. Prakash M.D (R.T), Dr Manne Srinivas, M.D (R.T)
DOI: https://dx.doi.org/10.18535/jmscr/v4i10.66
Abstract
Purpose: To analyze the results obtained in patients with post operative High Grade Astrocytomas treated by adjuvant Radiotherapy.
Materials and Methods: The study was carried out between 1996 and 1999 at Kasturba Medical College and Hospital, Manipal 576 119. This is a prospective randomized study of 26 patients,who were randomized to Whole Brain Radiotherapy(WBRT) and Limited Volume Brain Radiotherapy (LVBRT) groups in postoperative high grade astrocytomas. Both groups of patients received total dose of 60 Gy/30#/6 weeks with standard Radiotherapy technique based on pre and post operative CT scan reports and intraoperative findings.
The data was analysed for the prognostic factors like performance status, extent of surgery, grade of tumor. The radiation reactions (RTOG scale), survival patterns(for 6 months) were analysed.
Results: Majority (84.6%) of the patients were males. Patients with Grade III histology had better survival than patients with grade IV( 90%vs31.25%) Patients with WBRT group developed more acute reactions than LVBRT group (Grade II reactions69 vs 23%, grade III 23% vs 0). Patients treated for tumor volume <4x4cm2 had better survival than with patients with >4x4cm2, up to 6x6cm2(62% vs29%). Patients underwent near total excision had better survival than those biopsy alone(100% vs10%). The overall survival was 61% vs53% for WBRT vs LVBRT group. The observed test of significance was 0.546 and p values were <0.1%, which were not statistically significant.
Conclusion: Postoperative adjuvant Radiotherapy will provide better quality of life and survival benefit for the patients. The patients will not have a significant survival benefit whether treated by WBRT or by LVBRT. Hence, can be treated by LVBRT as there will be less toxicities. This study concepts were followed today with escalation of radiotherapy dose to the tumor and limiting dose to normal structures by latest and advanced techniques like Three Dimentional Conformal Therapy( 3D-CRT) or Intensity Modulated Radiotherapy (IMRT).
Key words: High grade gliomas ,Whole Brain Irradiation vs Limited Volume Brain Irradiation.
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