Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial.
OBJECTIVE
To prospectively compare standard radiation therapy (RT) with an abbreviated course of RT in older patients with glioblastoma multiforme (GBM).


METHODS
One hundred patients with GBM, age 60 years or older, were randomly assigned after surgery to receive either standard RT (60 Gy in 30 fractions over 6 weeks) or a shorter course of RT (40 Gy in 15 fractions over 3 weeks). The primary end point was overall survival. The secondary end points were proportionate survival at 6 months, health-related quality of life (HRQoL), and corticosteroid requirement. HRQoL was assessed using the Karnofsky performance status (KPS) and Functional Assessment of Cancer Therapy-Brain (FACT-Br).


RESULTS
All patients had died at the time of analysis. Overall survival times measured from randomization were similar at 5.1 months for standard RT versus 5.6 months for the shorter course (log-rank test, P =.57). The survival probabilities at 6 months were also similar at 44.7% for standard RT versus 41.7% for the shorter course (lower-bound 95% CI, -13.7). KPS scores varied markedly but were not significantly different between the two groups (Wilcoxon test, P =.63). Low completion rates of the FACT-Br (45%) precluded meaningful comparisons between the two groups. Of patients completing RT as planned, 49% of patients (standard RT) versus 23% required an increase in posttreatment corticosteroid dosage (chi(2) test, P =.02).


CONCLUSIONS
There is no difference in survival between patients receiving standard RT or short-course RT. In view of the similar KPS scores, decreased increment in corticosteroid requirement, and reduced treatment time, the abbreviated course of RT seems to be a reasonable treatment option for older patients with GBM.
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Cross Cancer Institute, 11560 University Ave, Edmonton, Alberta, Canada T6G 1Z2. wilsonro@cancerboard.ab.ca
Brasher
P M A
PM
Bauman
G
G
Anthes
M
M
Bruera
E
E
Chan
A
A
Fisher
B
B
Fulton
D
D
Gulavita
S
S
Hao
C
C
Husain
S
S
Murtha
A
A
Petruk
K
K
Stewart
D
D
Tai
P
P
Urtasun
R
R
Cairncross
J G
JG
Forsyth
P
P
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D019583:Dose Fractionation, Radiation; D005260:Female; D005909:Glioblastoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones