OBJECTIVE
To assess the feasibility of prescribing early chemotherapy to improve the patient’s functional status before starting radiation therapy for grade 4 gliomas.
MATERIAL AND METHODS
In a study involving a pairwise selection strategy, 54 patients (38.6%) after the surgical stage were prescribed early chemotherapy, which consisted of 1 to 6 courses with temozolomide (TMZ), and subsequent radiation therapy. In 86 patients (61.4%), the radiation stage was started within standard time frame after microsurgical intervention.
RESULTS
Large residual tumor, rapid early progression or marked postoperative changes with oedema and dislocation were the most frequent reasons for prescribing early chemotherapy with TMZ at a dose of 200 mg/m2. Often these factors were the cause of low functional status in patients. As a result of 1—6 courses with TMZ, 54 patients showed a significant improvement in their functional status (p=0.025). For grade 4 malignant gliomas, the median overall survival in the early chemotherapy group was 21.32 months (95% Cl: 13.0—29.6) and 19.68 months (95% Cl: 15.9—24.5; p=0.936) in the absence of chemotherapy. In glioblastoma with no IDH 1/2 mutation (grade 4), the median survival was slightly lower — 20.99 and 18.96 months, respectively (p=0.593). The Cox model identified the importance of specific treatment components for glioblastoma. The use of TMZ in the adjuvant mode (p=0.041), isoeffective dose level ≥59.5 Gy (α/β=7.5) regardless of the fractionation option used (p<0.0001) and bevacizumab as 2nd line therapy (p=0.003) improves overall survival rates. Early chemotherapy (p=0.575) and TMZ during radiotherapy (p=0.193) were not significant predictors of survival.
CONCLUSION
The data presented indicate the possibility of starting radiation therapy at a later date, if courses with TMZ are carried out in the interval between microsurgery and radiotherapy. The use of early chemotherapy does not worsen the prognosis in patients with grade 4 gliomas.
