Background: Glioblastoma multiforme (GBM) is a poorly differentiated, highly aggressive malignancy of the central nervous system (CNS). Although it carries a uniformly fatal prognosis, postoperative radiotherapy (RT) has been shown to increase the median survival compared with that for patients treated with surgery alone. Consequently, surgical resection followed by 6 weeks of RT has become the standard of care for the management of these tumors. The standard dose of radiation given after surgical resection is 60 Gy delivered in 1.8–2.0-Gy fractions. Hyperfractionation (giving a smaller fraction size twice daily) to a total dose of 72 Gy has shown no specific benefit for GBM. Although the methods of these trials varied in terms of fraction size, total dose, and overall treatment time, all were shown to have acceptable toxicity and encouraging results. From a radiobiologic standpoint, late-responding tissues such as neural tissue should be more responsive to fewer, but larger, dose fractions of radiation. Therefore, to control CNS tumors such as GBM adequately, it is likely that the radiation dose given must exceed the tolerance of the surrounding brain, resulting in an unacceptable side effect profile. If a greater biologic radiation dose can be delivered to tumor while selectively sparing normal brain through a specialized treatment technique such as Rapid Arc, it may be possible to increase patient survival without increasing toxicity. Objective: To evaluate the outcome using hypofractionated radiotherapy for treatment of all the stages of malignant glioma of brain in terms of locoregional control by clinical and radiological assessment. Method: This prospective observational study involves 30 histological proven, hematological stable cases of malignant glioma of brain was conducted during March 2018 - March 2019 in the department of Radiotherapy, Pt. JNM medical college and Regional cancer center (RCC) of Dr. BRAM Hospital Raipur. Informed written consent, detail history and complete Physical examination were performed in every patient. Patients were simulated with appropriate immobilization technique then planned with IMRT. Treatment planning was performed using VARIAN (eclipse V.S 13.6.23) treatment planning system. Dose to PTV and OARs were calculated. Follow up was done for 6 months. Patients were evaluated for local response. Result: In this study the majority of patients (33.3%) were of 50-60 years age group. 66.6% of participants were males and rests were females. There was equal tumor distribution noted in both halves of brain i.e. 50%. Frontal lobes (33.3%) followed by fronto -parietal were found to be most affected areas in brain. Complete response (CR) was seen in 33%,partial response (PR) was in 43.3% and progressive disease was observed in 20% of patients. Death occurred in 3.3% patients. In this study, patients group who belonged to 0-1cm (pre radiotherapy tumor size) showed complete response in 20%. In 4-5 cm group CR was observed in 10%. Conclusion: Glioma of brain is a very fatal disease and carries a poor prognosis overall. The mainstay of treatment in this disease is surgery followed by radiotherapy. The response post radiotherapy depends mainly on dose fractionation schedule and type and technique used for radiotherapy. In this study 30 patients were treated with rapid arc (RA) technique with fraction regimen of 2.3 Gy per fraction 5 days a week for 5-6 weeks along with Tab. Temozolamide 75mg/ m2 once a day daily concurrently. Follow up was done to assess the response and local control up to 6 months. This study reveals that high grade glioma mostly occurs at old age group and majority among men. Glioma of brain can involve any areas of brain, our study reveals that Frontal followed by fronto -parietal were found to be mostly affected. Complete response was observed in most patients who completed radiotherapy in some patients progressive disease was observed.
