title: Elderly patients with glioblastoma multiforme treated with concurrent temozolomide and standard- versus abbreviated-course radiotherapy.
abstract: BACKGROUND
  Glioblastoma multiforme (GBM) is an aggressive neoplasm, with controversy regarding treatment in elderly patients.
  
  
  OBJECTIVE
  To review outcomes of elderly patients aged ≥ 65 with newly diagnosed GBM treated with concurrent temozolomide and either standard-course radiotherapy (SRT) or abbreviated-course radiotherapy (ART).
  
  
  METHODS
  Retrospective review from 2003 to 2012.
  
  
  METHODS
  Survival, comparing treatment regimens. One hundred patients received SRT (median dose = 60 Gy), and 29 received ART (median dose = 35 Gy). O6- methylguanine-DNA methyltransferase (MGMT) status was available for 26 SRT and 13 ART recipients.
  
  
  RESULTS
  Median age was 70 years. Median follow-up was 11 months. At analysis, 3 patients were alive. Multivariate analysis of the entire cohort found SRT (hazard ratio [HR] = 0.421, p = 0.0001), Karnofsky Performance Score of 70 or higher (HR = 1.894, p = 0.0031), and more extensive surgery (HR = 0.466, p = 0.0023) were associated with longer survival time, but age was not. Median time to death with SRT was 13 months versus 5.4 months with ART, but the latter had worse prognostic factors, including lower Karnofsky Performance Scores, fewer gross total resections, and higher recursive partitioning analysis class. Recipients of SRT with methylated MGMT promoter had a trend toward longer survival compared with unmethylated MGMT (p = 0.06), but ART recipients had shorter survival with MGMT methylation (p = 0.02).
  
  
  CONCLUSIONS
  Elderly patients with multiple poor prognostic factors given ART had short survival times. Relative to other variables, MGMT status may not predict outcome for these patients.
authors: Radiation Oncologist at the Sunset Medical Center in Los Angeles, CA. christine.n.chang-halpenny@kp.org.
authors: Christine N
authors: CN
authors: Chang-Halpenny
authors: Radiation Oncologist at the Cancer Center of Irvine in CA. jyeh.md22@ccoi.org.
authors: Jekwon
authors: J
authors: Yeh
authors: Radiation Oncologist at the Sunset Medical Center in Los Angeles, CA. winston.w.lien@kp.org.
authors: Winston W
authors: WW
authors: Lien
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy* / Q000235:genetics / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011401:Promoter Regions, Genetic / Q000235:genetics; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide