A Medical Research Council trial of two radiotherapy doses in the treatment of grades 3 and 4 astrocytoma

NM Bleehen, SP Stenning - British journal of cancer, 1991 - nature.com
NM Bleehen, SP Stenning
British journal of cancer, 1991nature.com
A total of 474 adult patients with malignant glioma (astrocytoma) grade 3 or 4 were
randomised into an MRC study (BR2) comparing 45 Gy (in 20 fractions over 4 weeks) with
60 Gy (in 30 fractions over 6 weeks) of radiotherapy given post-operatively. Using 2: 1
randomisation, 318 patients were allocated the 60 Gy course and 156 the 45 Gy course.
Adjuvant chemotherapy was not given. The results show that a 60 Gy course produces a
modest lengthening of progression-free and overall survival. They suggest a statistically …
Abstract
A total of 474 adult patients with malignant glioma (astrocytoma) grade 3 or 4 were randomised into an MRC study (BR2) comparing 45 Gy (in 20 fractions over 4 weeks) with 60 Gy (in 30 fractions over 6 weeks) of radiotherapy given post-operatively. Using 2: 1 randomisation, 318 patients were allocated the 60 Gy course and 156 the 45 Gy course. Adjuvant chemotherapy was not given. The results show that a 60 Gy course produces a modest lengthening of progression-free and overall survival. They suggest a statistically significant prolongation of median survival from 9 months in the 45 Gy group to 12 months in the 60 Gy group (hazard ratio= 0.75, chi 2= 7.36, df= 1, P= 0.007). Over 80% of patients reported no morbidity from the radiotherapy, and there was no evidence of increased short-term morbidity in the higher dose group. Late morbidity was not assessed. A prognostic index defined in a previous MRC study was validated in this new cohort. It identifies a group of patients (20% of the total) with a 2 year survival rate of 28%(95% confidence interval 19% to 38%). It was apparent that the survival advantage to the higher dose was maintained even in the poorest prognostic groups defined by this index.
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