Study of clinical profile, toxicity and quality of life in high grade gliomas receiving chemoradiation

Research Article
*Dr. A. Satish kumar MD, Dr. M. John winkle MD DR. F. Soujanya MD Dr. G. R. Santhilatha MD, Dr. R. Priyanka MD and Dr G. Padmasri Ms
Gliomas, chemo radiation, adjuvant chemotherapy, External beam radiation, immobilisation, response evaluation criteria in solid tumors (RECIST) criteria.

Aim: Study of Clinical profile, Toxicity and Quality of life in high- grade Gliomas receiving Chemoradiation. Methodology: After obtaining institutional ethical committee approval and informed consent, a total no. of 20 patients were planned. It is hospital based observational prospective study was carried out in department of radiotherapy, Govt. General Hospital, Vijayawada for a period of 10 months Feb 2023 to Dec 2023. All the patients were staged with clinical examination, Chest X ray, and abdomen pelvis ultrasound. After initial staging all patients underwent a computed tomography (CT) scan and MRI Brain. External beam radiation therapy was delivered using linear accelerator with 6 MV photons. A dose of 60 Gy was delivered in 30 fractions, using a four shrinking field technique and was treated 5days/week. Concurrent chemotherapy was administered using Cap.Temozolamide 75mg/m2. Followed by monthly TMZ at a dose of 150- 200mg/m2 on 5 out of every 28days for 6 cycles. Weekly assessment was carried out and toxicity was graded according to the common criteriaversion3.0 Hemogram. RFT, LFT were repeated every week prior to clinical examination. Assessment of tumor response was done using clinical assessment and response  evaluation criteria in solid tumors (RECIST) criteria. Statistical analysis: Data was analyzed by obtaining rates and proportions. Chi- square test and T test was used to find the significance. This whole analysis was done using SPSS software version 26. Results:  Out of the 20 patients recruited for study, 19 patients came for first follow up after completion of chemo radiation and advised adjuvant chemotherapy. Only 18 patients completed adjuvant chemotherapy. Out of 20 patients, two persons did not go for adjuvant chemotherapy. The median follow up duration was 10 Months (Range 6-16 months). After 6 months MRI was done for all 20 patients, out of 20 Patients in 11 members has complete response of tumor (27 %), Partial response in 7 (18%), and 2 patients has Progressive disease (5%). Toxicities like Grade 1 headache (40%) during chemo radiation. Grade 1 vomiting’s (25%), Grade 2 toxicity in 2 patients (10%) during chemo radiation, Grade 1 nausea (20%), 1 patient had Grade 2 Nausea (5%). Both upper and lower Limb weakness had improved in 10% of the patients. They were no other toxicities like Blurring of vision, Double vision, decreasing of Hearing, Hematological toxicities, Dyselectrolytemia and Tinnitus. Conclusion: The  present study demonstrated a moderately clinically relevant improvement to HRQOL although there were patients with toxicities like headache, nausea and Vomiting during the course of chemo radiation, but overall Quality of life not Deteriorated. About 50% of the patients had very good tumor response with concurrent Chemo radiation where the quality of life is good in this group.