Temozolomide and Reirradiation in Recurrent Grade II Brain Glioma

Background This phase II trial was designed to assess the response rate, survival benefits and toxicity profile of temozolomide, and brain reirradiation using conformal radiotherapy (CRT) for recurrent grade II brain glioma. Between February 2006 and June 2009, 18 patients with recurrent low grade glioma, and two with recurrent ependymoma were enrolled in the study. Patients had to show unequivocal evidence of tumor recurrence on gadolinium-enhanced magnetic resonance imaging after failing conventional radiotherapy for initial disease. Methods Patients were treated by temozolomide at a dose of 200 mg/m2/day for chemonaive patients, and at a dose of 150 mg/m2/day for previously treated patients, for 4 - 5 cycles. Then, patients underwent reirradiation by CRT at a dose of 30 - 40 Gy by conventional fractionation. Results All the 20 patients were treated with temozolomide and reirradiation. Two patients achieved complete remission, and six achieved partial remission, with an overall objective response rate of 40%. The mean overall survival (OS) was 16 months (range, 6 - 24 months). The median OS was 15.5 months. Additionally, treatment significantly improved quality of life. Treatment was tolerated well with mild grade 1, 2 hematological toxicities, and nausea/vomiting in 15% and 39% of cycles, respectively. Conclusions Temozolomide and CRT had an anti-tumor activity in recurrent grade II brain glioma, and represented a good treatment hope for such patients.