Survival Outcomes with Two Short-Course Radiation Therapy Protocols in Elderly and Frail Patients with Glioblastoma: Results from a Retrospective Study | ||||
| SECI Oncology Journal | ||||
| Volume 12, Issue 3, July 2024, Page 257-261 | ||||
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| Abstract | ||||
| BACKGROUND: Glioblastoma multiforme (GBM) is a fatal brain malignancy with grave prognosis despite advances in treatment, with median overall survival still dismal, which is worst in elderly and frail patients PURPOSE: To evaluate progression free and Overall survival outcomes in elderly (aged 60 and above) or frail patients with glioblastoma multiforme (GBM) in a pilot retrospective study comparing two short-course radiation therapy fractionations. METHODS AND MATERIALS: Retrospective two arm study. Elderly (60 years and above) and /or frail patients (with ECOG 3) with a diagnosis of GBM were studied and reviewed. Total 76 patients were reviewed into one of two arms; Arm A: short-course RT (25 Gy in five fractions 5 Gy per fraction daily over a week) or arm B using 40 Gy in 15 fractions over 3 weeks 2.667 Gy per fraction. Treatment planning was either 3D conformal planning or intensity modulated radiotherapy (IMRT). Patients were analysed for progression free survival (PFS) and overall survival (OS) according to age, Eastern Cooperative Oncology Group (ECOG) Performance Status (KPS), and extent of surgery. For patients received concurrent chemotherapy tamozolamide 75 mg / m2 dose was used. Ethical committee approval was obtained. RESULTS: Median follow up period was 9.02 months (range: 3-16). Concurrent and adjuvant chemotherapy was given among 28/51 patients (54.9%) treated with 40 Gy in 15 fractions. The 25 Gy/5 fractions/ 1 week RT (25 patients) was better tolerated with less use of post treatment steroid use (28% vs 35.3% in arm B). The median OS time was 7.5 months (95% CI, 6.7-8.4 months) in arm A versus 9.7 months (95% CI, 8.9-10.6 months) in arm B (P=.0001). Median PFS and OS rates of whole cohort were 7.0 months and 9.0 months in arm A and arm B respectively. However, the median PFS was 5.4 months (95% confidence interval [CI], 4.8-6.5 months) in the five fractions (arm A) and 7.9 months (95% CI, 7.2-8.6 months) in 40 Gy/15 fx/3weeks (arm B) (P=.0.0001). CONCLUSIONS: A short-course RT regimen of 25 Gy in 5 fractions over a week was found inferior treatment option for elderly or frail patients with GBM as compared to 40 Gy in 15 fractions/ 3 weeks. This May be due to poor Performance of the patients assigned to the shorter arm of five fractions. Further prospective studies with larger numbers are needed. | ||||
| Keywords | ||||
| Gbm; Glioblastoma; Hypofractionation | ||||
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