Abbreviated Course of Radiation Therapy in Older Patients With Glioblastoma Multiforme: A Prospective Randomized Clinical Trial W. Roa, P.M.A. Brasher, G. Bauman, M. Anthes, E. Bruera, A. Chan, B. Fisher, D. Fulton, S. Gulavita, C. Hao, S. Husain, A. Murtha, K. Petruk, D. Stewart, P. Tai, R. Urtasun, J.G. Cairncross, and P. Forsyth A B S T R A C T Purpose To prospectively compare standard radiation therapy (RT) with an abbreviated course of RT in older patients with glioblastoma multiforme (GBM). Patients and Methods One hundred patients with GBM, age 60 years or older, were randomly assigned after surgery to receive either standard RT (60 Gy in 30 fractions over 6 weeks) or a shorter course of RT (40 Gy in 15 fractions over 3 weeks). The primary end point was overall survival. The secondary end points were proportionate survival at 6 months, health-related quality of life (HRQoL), and corticosteroid requirement. HRQoL was assessed using the Karnofsky performance status (KPS) and Functional Assessment of Cancer Therapy-Brain (FACT-Br). Results All patients had died at the time of analysis. Overall survival times measured from randomization were similar at 5.1 months for standard RT versus 5.6 months for the shorter course (log-rank test, P = .57). The survival probabilities at 6 months were also similar at 44.7% for standard RT versus 41.7% for the shorter course (lower-bound 95% CI, -13.7). KPS scores varied markedly but were not significantly different between the two groups (Wilcoxon test, P = .63). Low completion rates of the FACT-Br (45%) precluded meaningful comparisons between the two groups. Of patients completing RT as planned, 49% of patients (standard RT) versus 23% required an increase in posttreatment corticosteroid dosage ( 2 test, P = .02). Conclusion There is no difference in survival between patients receiving standard RT or short-course RT. In view of the similar KPS scores, decreased increment in corticosteroid requirement, and reduced treatment time, the abbreviated course of RT seems to be a reasonable treatment option for older patients with GBM. J Clin Oncol 22:1583-1588. © 2004 by American Society of Clinical Oncology INTRODUCTION Glioblastoma multiforme (GBM) is the most common glioma and accounts for 40% of primary CNS malignancies. Among older patients, GBM accounts for the majority of primary brain tumors. The age-adjusted incidence of brain tu- mors in older patients ( 60 years old) has been increasing steadily (ie, indepen- dent of the increase in the number of older patients) and will continue to do so. 1 The most significant prognostic factor in GBM is age, followed by Karnofsky per- formance status (KPS), histology, and mental status. 2 Older patients with a limited functional status do particularly badly and have median survivals of only a few months, and there are no long-term survivors. 3,4 Current treatment for pa- tients with GBM, including surgical resection, radiation therapy (RT), and chemotherapy, is partially effective; rare- ly patients are cured of their disease. As yet, no clinical, radiographic, patho- logic, or molecular alteration in GBM predicts a favorable response to either RT or chemotherapy. From the Cross Cancer Institute; Divi- sion of Epidemiology, Prevention and Screening, Alberta Cancer Board; De- partments of Oncology, Laboratory Medicine and Pathology, and Surgery, University of Alberta, Edmonton; De- partments of Oncology and Clinical Neurosciences, University of Calgary and Tom Baker Cancer Center, Calgary, Alberta; London Regional Cancer Cen- ter, London; Northwestern Regional Cancer Center, Thunder Bay, Ontario, Canada; and M.D. Anderson Cancer Center, Houston, TX. Submitted June 18, 2003; accepted December 9, 2003. This project was supported by the Re- search Initiative Program of the Alberta Cancer Board. This study was presented in part on February 7 and 8, 2003, at the Cana- dian Brain Tumor Consortium Investiga- tor’s Meeting, Lake Louise, Alberta, Canada. Authors’ disclosures of potential con- flicts of interest are found at the end of this article. Address reprint requests to Wilson Roa, MD, Cross Cancer Institute, 11560 University Ave, Edmonton, Alberta, Canada T6G 1Z2; e-mail: wilsonro@cancerboard.ab.ca. © 2004 by American Society of Clinical Oncology 0732-183X/04/2209-1583/$20.00 DOI: 10.1200/JCO.2004.06.082 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T VOLUME 22  NUMBER 9  MAY 1 2004 1583 Downloaded from ascopubs.org by 54.87.23.211 on June 5, 2022 from 054.087.023.211 Copyright © 2022 American Society of Clinical Oncology. All rights reserved.