Abstract
INTRODUCTION: Glioblastoma (GBM) is a devastating condition with limited treatment options. Patients with poor performance status often receive hypofractionated radiotherapy (RT) and are at risk of severe toxicity. Sheltens Scale is a semiquantitative method of assessing white matter hyperintensities (WMH) on T2 weighted brain MRIs. WMH have been associated with increased risk of stroke, dementia and death.We hypothesised that a high Scheltens score would indicate a vulnerable brain and predict increased toxicity from RT and could be used to select patients for RT or alternative treatments. METHOD: In this pilot study we retrospectively identified 24 patients with confirmed GBM who received hypofractionated RT between 2007-2013. Pre-RT MRI scans were assessed using modified Scheltens Scale (rating the contralateral hemisphere). In the absence of accurate toxicity data, scores were correlated with overall survival. RESULTS: Age ranged from 50-77 (median 73). Sheltens scores ranged from 6-25 (median 17) and median survival was 26 weeks. There was a trend towards reduced survival with higher Scheltens score but this was not significant (r = -0.148, p = 0.489). The trend persisted for individual brain regions and after stratification by MGMT methylation status. CONCLUSION: We have demonstrated the feasibility of measuring Sheltens Scale in GBM patients receiving short course RT. The study was limited by small numbers and the use of survival as a surrogate of toxicity. We propose a prospective study comparing Scheltens scores with acute and late RT toxicities in this vulnerable population.