Hypofractionated radiotherapy for poor prognosis malignant glioma: matched pair survival analysis with MRC controls J.J. McAleese a , S.P. Stenning b , S. Ashley a , D. Traish a , F. Hines a , S. Sardell a , D. Guerrero a , Michael Brada a, * a Neuro-Oncology Unit and Academic Unit of Radiotherapy and Oncology, The Institute of Cancer Research and The Royal Marsden NHS Trust, London, UK b MRC, Clinical Trials Unit, 222 Euston Road, London NW1 2DA, UK Received 8 July 2002; received in revised form 13 January 2003; accepted 15 February 2003 Abstract Purpose: To assess the survival benefit of palliative hypofractionated radiotherapy in patients with poor prognosis high grade glioma by a matched comparison to conventionally treated controls. Method: Ninety-two elderly and/or disabled patients with high grade glioma with poor prognostic features received palliative partial brain radiotherapy to a dose of 30 Gy in six fractions over 2 weeks. Patients were matched for WHO histological grade, performance status and age from a cohort of patients treated with conventionally fractionated radiotherapy to a dose of 60 Gy in 30 fractions in an Medical Research Council (MRC) BR05 trial. Results: Patients treated with hypofractionated radiotherapy had a median survival of 5 months with a 1-year survival rate of 12% from diagnosis. The median survival of case-matched controls was estimated to be 2.5 – 4.5 months longer. Following hypofractionated radiotherapy, Barthel score was improved or remained stable in 68% of patients. Conclusion: Hypofractionated partial brain radiotherapy is a well-tolerated regimen with palliative benefit. Comparison with matched controls suggests lesser survival benefit than would be obtained with radical radiotherapy. However, this is compensated by lower intensity and duration of irradiation induced side effects. It is postulated that there may not be a significant difference in good quality survival or ‘quality adjusted survival’ between the two regimens and this requires testing in prospective trials. q 2003 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Radiotherapy; High grade glioma; Palliation 1. Introduction Prognosis in patients with high grade glioma is determined by performance status, age and histological grade. In Radiotherapy and Oncology Group (RTOG) studies, patients aged . 50 years with a Karnofsky performance status (KPS) , 70 treated with radical radio- therapy had a median survival of 4.6 – 8.9 months [3]. In the Medical Research Council (MRC) trials, the median survival of patients aged . 60 years with a poor perform- ance status (WHO performance status . 3) following radical radiotherapy was 7.7 months [10]. Although radio- therapy provides a survival benefit with an overall median survival of 9 – 12 months, the impact of radical treatment on survival in the different prognostic subgroups is not known [9,13,20]. In the palliative situation of poor prognosis patients with high grade glioma, survival gain has to be balanced against treatment morbidity and the effect on quality of life. Most radical radiotherapy regimes employed in the treatment of high grade glioma are given to high doses over a period of 4 – 6 weeks. An intensive course of 60 Gy over 6 weeks while providing optimum survival gain [2,11,21] may be inappropriate for patients destined to survive 6 months or less, where treatment and its after effects may take up to a third to a half of remaining life. We, therefore, investigated a short palliative regime of 30 Gy in six fractions over 2 weeks reported previously [17]. The regime was well tolerated, convenient and provided effective palliation in patients with poor prognosis high grade glioma. However, the potential survival benefit was not defined. In 0167-8140/03/$ - see front matter q 2003 Elsevier Science Ireland Ltd. All rights reserved. doi:10.1016/S0167-8140(03)00077-X Radiotherapy and Oncology 67 (2003) 177–182 www.elsevier.com/locate/radonline * Corresponding author. The Institute of Cancer Research and The Royal Marsden NHS Trust, Downs Road, Sutton, Surrey SM2 5PT, UK.