Multicentric glioblastoma treated with hypofractionated holocraneal radiotherapy and concurrent temozolomide
Keywords:
multicentric glioblastoma, hypofractionated radiation therapy, concurrent chemotherapy, holocraneal radiotherapy, temozolomide, brain tumor.Abstract
OBJECTIVE: To describe the tolerance and survival of three patients with multicentric glioblastoma treated with hypofractionated holocraneal radiotherapy and concurrent temozolomide.CASE REPORT: Three patients are reported here, two men and one woman, they were diagnosed with multicentric glioblastoma at the Ramón y Cajal Hospital (Madrid, Spain), from 2016 to 2017. The average age was 62 years. They had at least four brain lesions and bilateral involvement. This research studied the presence of gene promoter MGMT methylation, the mutation in isocitrate dehydrogenase gene, the mutation in ATRX protein function regulating gene, the mutation in p53 tumor suppressor gene, and the heterozygosity loss in the short arm of chromosome 1 (1p) and in the long arm of chromosome 19 (19q). These three patients were surgically operated and subsequently received holocraneal radiotherapy: hypofractioned scheme at 37.5 or 40.05 Gy doses in 15 fractions (2.5 G and 2.67 Gy / fraction respectively) with concurrent temozolomide (75 mg / m2 ), followed by adjuvant temozolomide. The average survival was ten months. Two patients died from tumor progression; and the other, for respiratory infection.
CONCLUSIONS: The treatment with holocraneal radiotherapy with hypofractionation and concurrent temozolomide is very well tolerated and similar survivals is obtained to other more complex and longer lasting managements. Therefore, it may be a therapeutic option in patients with multicentric glioblastoma.
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