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Standard dose and dose-escalated radiation therapy are associated with favorable survival in select elderly patients with newly diagnosed glioblastoma

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Abstract

We hypothesized elderly patients with good Karnofsky Performance Status (KPS) treated with standard dose or dose-escalated radiation therapy (SDRT/DERT) and concurrent temozolomide (TMZ) would have favorable overall survival (OS) compared to historical elderly patients treated with hypofractionated RT (HFRT). From 2004 to 2015, 66 patients age ≥ 60 with newly diagnosed, pathologically proven glioblastoma were treated with SDRT/DERT over 30 fractions with concurrent/adjuvant TMZ at a single institution. Kaplan–Meier methods and the log-rank test were used to assess OS and progression-free survival (PFS). Multivariate analysis (MVA) was performed using Cox Proportional-Hazards. Median follow-up was 12.6 months. Doses ranged from 60 to 81 Gy (median 66). Median KPS was 90 (range 60–100) and median age was 67 years (range 60–81), with 29 patients ≥ 70 years old. 32% underwent gross total resection (GTR). MGMT status was known in 28%, 42% of whom were methylated. Median PFS was 8.3 months (95% CI 6.9–11.0) and OS was 12.7 months (95% CI 9.7–14.1). Patients age ≥ 70 with KPS ≥ 90 had a median OS of 12.4 months. Median OS was 27.1 months for MGMT methylated patients. On MVA controlling for age, dose, KPS, MGMT, GTR, and adjuvant TMZ, younger age (HR 0.9, 95% CI 0.8–0.9, p < 0.01), MGMT methylation (HR:0.2, 95% CI 0.1–0.7, p = 0.01), and GTR (HR:0.5, 95% CI 0.3–0.9, p = 0.01) were associated with improved OS. Our findings do not support routine use of a standard 6-week course of radiation therapy in elderly patients with glioblastoma. However, a select group of elderly patients with excellent performance status and MGMT methylation or GTR may experience favorable survival with a standard 6-week course of treatment.

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Funding

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Michigan Medical Center, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-0010, USA

    William C. Jackson, Daniel R. Wahl, Daniel E. Spratt, Yue Cao, Theodore S. Lawrence & Michelle M. Kim

  2. Department of Radiation Oncology, School of Medicine Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA

    Christina I. Tsien

  3. Department of Neuro-Oncology, University of Michigan, Ann Arbor, MI, USA

    Larry Junck & Denise Leung

  4. Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA

    Shawn Hervey-Jumper, Daniel Orringer & Jason Heth

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  1. William C. Jackson
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  2. Christina I. Tsien
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  8. Daniel R. Wahl
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  10. Yue Cao
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  11. Theodore S. Lawrence
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Correspondence to Michelle M. Kim.

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This article does not contain any studies with human participants or animals performed by any of the authors. This retrospective analysis was approved through the local institutional review board.

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Jackson, W.C., Tsien, C.I., Junck, L. et al. Standard dose and dose-escalated radiation therapy are associated with favorable survival in select elderly patients with newly diagnosed glioblastoma. J Neurooncol 138, 155–162 (2018). https://doi.org/10.1007/s11060-018-2782-z

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  • DOI: https://doi.org/10.1007/s11060-018-2782-z

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