title: Feasibility evaluation of hypofractionated radiotherapy with concurrent temozolomide in elderly patients with glioblastoma.
abstract: BACKGROUND
  Although hypofractionated radiotherapy (HFRT) is preferred to conventionally fractionated radiotherapy when treating elderly patients with glioblastoma, the benefits and tolerability of HFRT with concurrent temozolomide (TMZ) remain unknown for such patients. We assessed the feasibility and outcomes of elderly patients with glioblastoma treated with HFRT and concurrent TMZ.
  
  
  METHODS
  We retrospectively reviewed the medical records of 11 patients aged ≥70 years who were treated with HFRT and concurrent TMZ. All patients had newly diagnosed and histologically confirmed glioblastoma and were treated at our institution between October 2011 and April 2015. The median age was 74 years (range, 70-85 years). Total resection/subtotal resection/biopsy were performed in 2/5/4 patients, respectively. The planning target volume included the T1-enhancing tumor and the resection cavity plus 2-cm margins, and all surrounding edema. The median prescription dose was 35 Gy (range, 35-42.5 Gy), delivered in 10 fractions. Seven patients received TMZ at 150 mg/m2for 5 days and 4 received TMZ at 75 mg/m2during HFRT. Overall survival (OS) was defined as the time from surgery to death or the last follow-up.
  
  
  RESULTS
  The median follow-up period was 13.2 months. The median OS and progression-free survival (PFS) times were 13.2 and 7.0 months, respectively. One patient experienced grade 4 neutropenia, lymphocytopenia, and thrombocytopenia. No grade 3 or higher nonhematological adverse event was noted.
  
  
  CONCLUSIONS
  Our analysis demonstrated the feasibility of HFRT with concurrent TMZ used to treat elderly patients with glioblastoma. Further prospective clinical trials are needed to define therapies that balance efficacy with tolerability.
authors.affiliation: Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Uto
authors.affiliation: Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. mizo@kuhp.kyoto-u.ac.jp.
authors.forename: Takashi
authors.identifier: http://orcid.org/0000-0002-8135-8746
authors.initials: T
authors.lastname: Mizowaki
authors.affiliation: Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Ogura
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Arakawa
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Mineharu
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hiraoka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects; D001932:Brain Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D007970:Leukopenia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D008297:Male; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D000077204:Temozolomide; D013921:Thrombocytopenia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Elderly; Glioblastoma; Hypofractionated radiotherapy; Temozolomide