Short-course palliative hypofractionated radiotherapy in patients with poor-prognosis high-grade glioma: quality-of-life outcomes from a prospective phase II study

Purpose: To report longitudinal quality-of-life (QoL) outcomes in patients with poor prognosis high-grade glioma (HGG) treated with palliative hypofractionated radiotherapy (RT). Methods: : Patients with poor-prognosis HGG based on age and performance status were accrued on a prospective study of short course palliative hypofractionated RT delivering 35Gy in 10 fractions over 2 weeks after written informed consent. European Organization for Research and Treatment of Cancer ( EORTC) QoL core questionnaire (QLQ-C30) and brain cancer module (BN20) were used in English or validated Indian vernacular languages (Hindi and Marathi) for QoL assessment at baseline (pre-RT), conclusion of RT, 1-month post-RT and subsequently at 3-monthly intervals until disease progression/death. Summary QoL scores were compared longitudinally over time by related samples Friedman’s two-way test. Results: : Forty-nine (89%) of 55 patients completed the planned course of hypofractionated RT. Longitudinal QoL data was available in 42 (86%) patients that constitutes the present study cohort. Median age of included patients comprising mainly of glioblastoma (81%) was 57 years with median baseline Karnofsky score of 60. Baseline QoL scores of included patients were significantly worse for several domains compared to historical institutional cohort of HGG patients treated previously with conventionally fractionated RT indicating negative selection bias. QoL scores remained stable for most domains after palliative hypofractionated RT with statistically significant improvements in fatigue (p=0.032), dyspnea (p=0.042) and motor dysfunction (p=0.036) over time. Conclusion: Short-course palliative hypofractionated RT in patients with poor-prognosis HGG is associated with stable and/or improved QoL scores in several domains making it a viable resource-sparing regimen.