title: Hypofractionated radiation therapy versus standard fractionated radiation therapy with concurrent temozolomide in elderly patients with newly diagnosed glioblastoma.
abstract: OBJECTIVE
  Adjuvant hypofractionated radiation therapy (HRT) for elderly patients with newly diagnosed glioblastoma (GBM) is a reasonable option compared with standard fractionation radiation therapy (SFRT). Outcomes in patients receiving HRT in the presence of temozolomide (TMZ) compared with SFRT with TMZ are unclear. We examined HRT for GBM with TMZ in comparison to SFRT with TMZ.
  
  
  METHODS
  We conducted a retrospective analysis of patients ≥60 years of age with newly diagnosed GBM who received SFRT or HRT from 1994 to 2014 in the postoperative setting. Inclusion criteria included SFRT (60 Gy/30 fractions or 59.4 Gy/33 fractions) versus HRT (40 Gy/15 fractions).
  
  
  RESULTS
  In this cohort, 158 patients were treated with SFRT versus 26 with HRT. Median survival in patients receiving SFRT compared with HRT was 430 and 475 days (P = .550), respectively. Ninety-five percent of the SFRT patients received TMZ versus 100% of those treated with HRT. Patients receiving HRT were older (median, 72 vs 66 years). All HRT patients were treated with the intensity modulated radiation therapy (IMRT) technique versus SFRT, in which 57% had IMRT. Multivariate Cox regression showed decreased overall survival (OS) associated with patient age >70 (hazard ratio [HR], 1.84), lower Karnofsky performance status (HR, 5.25), biopsy versus surgical resection (HR, 4.18), radiation therapy planning technique 3- or 2-dimensional planning versus IMRT (HR, 1.91; HR, 3.40, respectively). Analysis restricted to patients receiving IMRT-based planning showed no difference in OS between HRT and SFRT. For patients receiving TMZ, there was no survival difference between those treated with HRT and those treated with SFRT.
  
  
  CONCLUSIONS
  Elderly GBM patients receiving HRT and those receiving SFRT had similar OS. Subset analysis patients receiving concurrent TMZ showed no difference in OS between the HRT and SFRT groups.
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York. Electronic address: tjw2117@cumc.columbia.edu.
authors.forename: Tony J C
authors.initials: TJC
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
authors.forename: Cheng-Chia
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
authors.forename: Ashish
authors.initials: A
authors.lastname: Jani
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
authors.forename: Juan
authors.initials: J
authors.lastname: Estrada
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Timothy
authors.initials: T
authors.lastname: Ung
authors.affiliation: Department of Radiology, Columbia University Medical Center, New York, New York.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Chow
authors.affiliation: Department of Radiology, Columbia University Medical Center, New York, New York.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Soun
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
authors.forename: Shumaila
authors.initials: S
authors.lastname: Saad
authors.affiliation: The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York.
authors.forename: Yasir H
authors.initials: YH
authors.lastname: Qureshi
authors.affiliation: Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Robyn
authors.initials: R
authors.lastname: Gartrell
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
authors.forename: Heva J
authors.initials: HJ
authors.lastname: Saadatmand
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
authors.forename: Anurag
authors.initials: A
authors.lastname: Saraf
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Garrett
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
authors.forename: Christopher
authors.initials: C
authors.lastname: Grubb
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, New York, New York; Department of Neurological Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Isaacson
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.
authors.forename: Simon K
authors.initials: SK
authors.lastname: Cheng
authors.affiliation: Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Department of Neurological Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Sisti
authors.affiliation: Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Department of Neurological Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Bruce
authors.affiliation: Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Department of Neurological Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Sheth
authors.affiliation: Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Department of Neurology, Columbia University Medical Center, New York, New York.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Lassman
authors.affiliation: Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Department of Neurology, Columbia University Medical Center, New York, New York.
authors.forename: Fabio M
authors.initials: FM
authors.lastname: Iwamoto
authors.affiliation: Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Department of Neurological Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Guy M
authors.initials: GM
authors.lastname: McKhann
mesh_terms: D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019583:Dose Fractionation, Radiation; D005260:Female; D005909:Glioblastoma; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide