Choice of the fractionation regimen in treatment of high-grade gliomas (part 2): functional state and RPA classes

Based on the analysis of treatment outcomes of 396 patients with histologically verified grade 3-4 brain gliomas, indications for conventional and average fractionation regimens have been developed. The conventional fractionation regimen with a single dose of 2 Gy is more preferable to use for patients with high-grade gliomas, who have Karnofsky performance status (RPS) of 60-100 % and belong to RPA class I-III. Reaching the total dose to 60-62 Gy in grade 4 gliomas and to 54-56 in grade 3 gliomas is an important factor for improving the overall survival rate. The average fractionation regimen with a single dose of 3 Gy is possible to use for patients with primary low functional state (RPS 30-50 %) and RPA classes IV-VI. The total dose 45 Gy and more appears to be appropriate.