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Short-course radiotherapy in elderly patients with glioblastoma: feasibility and efficacy of results from a single centre

Kurzzeitstrahlentherapie bei älteren Glioblastompatienten: Durchführbarkeit und Effektivität der Ergebnisse einer einzelnen Einrichtung

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Abstract

Background

The incidence of glioblastoma (GBM) in the elderly population is currently increasing, with a peak seen between 65 and 84 years. The optimal treatment in terms of both efficacy and quality of life still remains a relevant and debated issue today.

The purpose of our study was to evaluate the feasibility of short-course hypofractionated accelerated radiotherapy (HART) in GBM patients aged over 70 years and with a good Karnofsky performance score (KPS).

Methods

A review of medical records at the “Istituto Neurologico C. Besta” was undertaken; patients aged ≥ 70 years who had undergone adjuvant HART for GBM between January 2000 and January 2004 were included in the study. HART was administered to a total dose of 45 Gy, 2.5 Gy/fraction, in three daily fractions for three consecutive days/cycle fractions each, delivered in two cycles (split 15 days).

Results

A total of 33 patients were evaluable for the current analysis. Median follow-up was 10 months. According to CTCAE (version 3.0) criteria, none of the patients developed radiation-induced neurological status deterioration or necrosis. KPS evaluation after HART was found to be stable in 73 % of patients, improved in 24 %, and worse in 3 %.

The median overall survival time of the entire study population was 8 months (range 2–24).

Conclusions

Our findings suggest that a hypofractionated accelerated schedule can be a safe and effective option in the treatment of GBM in the elderly.

Zusammenfassung

Hintergrund

Gegenwärtig ist die Inzidenz für Glioblastome (GBM) in der älteren Bevölkerung mit einem Gipfel zwischen 65 und 84 Jahren erhöht. Die optimale Behandlungsstrategie in Bezug auf Effektivität und Lebensqualität ist weiterhin kontrovers. In der Studie werden Durchführbarkeit, Toxizität und Effektivität einer hypofraktionierten, akzelerierten Strahlentherapie (HART) als adjuvante Therapie des Glioblastoms bei älteren Patienten (≥ 70 Jahre) mit einem guten Karnofsky-Performance-Status (KPS ≥ 70) untersucht.

Methoden

Es erfolgte eine Durchsicht der Krankenakten des Neurologischen Instituts ‚’C. Besta“. Patienten (≥ 70 Jahre), die eine adjuvante HART bei GBM zwischen Januar 2000 und Januar 2004 erhalten hatten, wurden in die Studie aufgenommen. Appliziert wurden 45 Gy HART über zwei 3-Tage-Zyklen mit 15 Tagen Pause dazwischen. Jeder Zyklustag bestand aus 3 Fraktionen zu je 2,5 Gy/Fraktion (9 Fraktionen je 3-Tage-Zyklus).

Ergebnisse

33 Patienten wurden in die Analyse eingeschlossen. Die mittlere Nachbeobachtungsdauer betrug 10 Monate. Nach CTCAE-Kriterien (Version 3.0) erlitt keiner der Patienten eine bestrahlungsinduzierte Demenz oder Radionekrose. Die KPS-Auswertung erwies sich nach HART bei 73 % der Patienten als stabil, bei 24 % als verbessert und bei 3 % als verschlechtert. Die Studienpopulation hatte eine mediane Gesamtüberlebenszeit von 8 Monaten (2–24 Monate). Die Operationsmethode erschien der einzig günstige Prognosefaktor für das Überleben (p< 0,01) zu sein.

Schlussfolgerung

Die Resultate unserer Studie zeigen, dass die hypofraktionierte, akzelerierte Strahlentherapie eine sichere und wirksame Behandlungsoption für ältere Patienten mit GBM sein kann.

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Acknowledgements

We wish to thank Elena De Martin, PhD, of the Division of Medical Physics (Neurological Carlo Besta Institute Foundation, Milan, Italy), for her contribution to editing the manuscript in its German version and Chiara Falcone, PhD, of the Division of Epidemiology (Neurological Carlo Besta Institute Foundation, Milan, Italy) for her contributions to statistical analysis.

Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Departement of Neurosurgery, Division of Radiotherapy, Neurological Carlo Besta Institute Foundation, via Celoria 11, 20133, Milan, Italy

    L. Fariselli, V. Pinzi, I. Milanesi & M. Marchetti

  2. Division of Neurooncology, Neurological Carlo Besta Institute Foundation, Milan, Italy

    A. Silvani & A. Salmaggi

  3. Epidemiology Unit, Neurological Carlo Besta Institute Foundation, Milan, Italy

    M. Farinotti

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  1. L. Fariselli
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Correspondence to V. Pinzi.

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Fariselli, L., Pinzi, V., Milanesi, I. et al. Short-course radiotherapy in elderly patients with glioblastoma: feasibility and efficacy of results from a single centre. Strahlenther Onkol 189, 456–461 (2013). https://doi.org/10.1007/s00066-013-0346-x

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