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Short-course Radiotherapy in Elderly and Frail Patients with Glioblastoma Multiforme. A Phase II Study

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Abstract

Purpose. To evaluate efficacy of short-course radiotherapy (RT) in elderly (≥60 years) and frail [Karnofsky performance status (KPS) 50–70] patients with glioblastoma multiforme (GBM).

Materials and methods. Between January 1987 and June 1993, a total of 47 elderly and frail patients with histological diagnosis of GBM entered into a phase II study. RT alone was administered with tumor dose of 45 Gy in 15 daily fractions in 15 treatment days in 3 weeks to a target volume described as tumor visible on CT scan and a 2-cm margin.

Results. Forty-four patients were evaluable for this analysis. There were 15 (34%) CR and 11 (25%) PR, making the overall response rate of 60%. Median duration of response was 9 months (range, 2–36 months). Improvement in pretreatment performance status was observed in 20/44 (45%) patients, 5 of which improved their KPS for 20%. Median survival time is 9 months, and 1–4 year survival rates are 39%, 6.8%, 4.5%, and 0, respectively, while median time to tumor progression is 8 months, and 1–4 year progression-free survival rates are 30%, 4.5%, 4.5%, and 0, respectively. Females did significantly better than males, patients with KPS 60–70 did significantly better than those with KPS 50, patients having tumors 4–5 cm did significantly better than those with tumors 6–8 cm as well as did those with more radical surgery when compared to those with biopsy only. On multivariate analysis, only tumor size and extent of surgery were found to independently influence survival. Acute toxicity was generally assessed as mild. One of the 12 (8%) autopsied patients had RT-induced brain necrosis.

Conclusion This shortened RT appears to be an effective tool in palliation of elderly and frail patients with GBM. Further studies with more patients are needed before testing it against more aggressive treatment approaches in this patient population.

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Authors and Affiliations

  1. Department of Oncology, University Hospital, Kragujevac, Yugoslavia

    Branislav Jeremic, Biljana Milicic, Nebojsa Nikolic, Aleksandar Dagovic & Jasna Aleksandrovic

  2. Department of Oncology, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan

    Yuta Shibamoto

  3. Institute of Neurosurgery, Clinical Center, Belgrade, Yugoslavia

    Danica Grujicic

  4. Department of Neurology, University Hospital, Kragujevac, Yugoslavia

    Miroslav Stojanovic

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  1. Branislav Jeremic
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Jeremic, B., Shibamoto, Y., Grujicic, D. et al. Short-course Radiotherapy in Elderly and Frail Patients with Glioblastoma Multiforme. A Phase II Study. J Neurooncol 44, 85–90 (1999). https://doi.org/10.1023/A:1006356021734

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