Short Course Hypofractionated Radiotherapy versus Conventional Radiotherapy for Poor Prognosis Glioblastoma Multiforme: A Randomised Controlled Trial

Introduction: Glioblastoma Multiforme (GBM) has a variegated outcome due to several prognostic factors, radiotherapy dose being one of them. Aim: To find whether short course hypofractionated Radiotherapy (RT) in poor prognosis GBM is equivalent to standard 6 weeks of RT, in terms of survival and Quality of Life (QOL). Materials and Methods: Patients of GBM belonging to Radiotherapy Oncology Group Recursive Partitioning Analysis (RTOG RPA) class IV, V and VI were prospectively randomised into study arm (35Gy in 7 fractions over 15 days) and control arm (60Gy in 30 fractions over 6 weeks). A sample size of 40 with 20 patients in each arm was decided. The changes in Karnofsky Performance Status (KPS), Clinical Performance Status (CPS) and Neurological Performance Status (NPS) were noted as an assessment of QOL. Kaplan Meier method was used to analyse the overall survival and progression free survival. Log rank test was used to test the difference between the survival curves. Results: The two arms had similar demographic profile. The survival outcomes were identical for patients in the study arm (median survival 7.2 months) and the control arm (median survival 10.4 months) with log rank p=0.09. Freedom from progression was also identical at a median value of 5.5 months vs. 3.8 months, log rank p=0.34. The two arms had no difference in terms of QOL i.e., KPS, CPS and NPS. Conclusion: Hypofractionated short course RT is equivalent to standard 6 weeks RT for poor prognosis GBM patients both in terms of survival and QOL.