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Chemoradiation in elderly patients with glioblastoma from the multi-institutional GBM-molRPA cohort: is short-course radiotherapy enough or is it a matter of selection?

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A Correction to this article was published on 12 May 2020

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Abstract

Background

The optimal radiotherapy regimen in elderly patients with glioblastoma treated by chemoradiation needs to be addressed. We provide the results of a comparison between conventionally fractionated standard radiotherapy (CRT) and short-course radiotherapy (SRT) in those patients treated by temozolomide-based chemoradiation.

Methods

Patients aged 65 years or older from the GBM-molRPA cohort were included. Patients who were planned for a ≥ 6-week or ≤ 4-week radiotherapy were regarded as being treated by CRT or SRT, respectively. The median RT dose in the CRT and SRT group was 60 Gy in 30 fractions and 45 Gy in 15 fractions, respectively.

Results

A total of 260 and 134 patients aged older than 65 and 70 years were identified, respectively. CRT- and SRT-based chemoradiation was applied for 192 (73.8%) and 68 (26.2%) patients, respectively. Compared to SRT, CRT significantly improved MS from 13.2 to 17.6 months and 13.3 to 16.4 months in patients older than 65 years (P < 0.001) and 70 years (P = 0.002), respectively. Statistical significance remained after adjusting for age, performance status, surgical extent, and MGMT promoter methylation in both age groups. The benefit was clear in all subgroup analyses for patients with Karnofsky performance score 70–100, Karnofsky performance score ≤ 60, gross total resection, biopsy, methylated MGMT promoter, and unmethylated MGMT promoter (all P < 0.05).

Conclusion

CRT significantly improved survival compared to SRT in elderly glioblastoma patients treated with chemoradiation in selected patients amenable for chemoradiation. This study is hypothesis-generating and a prospective randomized trial is urgently warranted.

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Change history

  • 12 May 2020

    The name of author Do Hoon Lim was incorrect in the initial online publication. The original article has been corrected.

Abbreviations

GMB:

Glioblastoma

TMZ:

Temozolomide

RT:

Radiotherapy

CRT:

Conventionally fractionated standard radiotherapy

SRT:

Short-course radiotherapy

MGMT :

O6-methylguanine-DNA methyltransferase

GBM-molRPA:

Glioblastoma molecular recursive partitioning analysis

GTR:

Gross total resection

MS:

Median survival

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Correspondence to Il Han Kim.

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The authors declare that we have no conflict of interest.

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This study was approved by every institutional review boards of participating institutions (Seoul National University Hospital IRB No. 1804-144-941). For this type of study formal consent is not required.

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The original version of this article has been revised: The seventh author’s name has been corrected.

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Wee, C.W., Kim, I.H., Park, CK. et al. Chemoradiation in elderly patients with glioblastoma from the multi-institutional GBM-molRPA cohort: is short-course radiotherapy enough or is it a matter of selection?. J Neurooncol 148, 57–65 (2020). https://doi.org/10.1007/s11060-020-03468-x

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