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International Atomic Energy Agency Randomized Phase III Study of Radiation Therapy in Elderly and/or Frail Patients With Newly Diagnosed Glioblastoma Multiforme.

Al's Comment:

 This reports on a clinical trial comparing a shorter course of radiation for the elderly with glioblastomas.  There was no difference when they cut the radiation to 1 week compared to 3 weeks and the total dose of radiation cut by about 45%.  Both resulted in short survival and progression free survival times and had equal quality of life, so it seems that for the elderly (or frail) patients, we can cut the radiation to just 1 week which is a lot easier for the patient, without changing the outcome.


Posted on: 09/28/2015

  J Clin Oncol. 2015 Sep 21. pii: JCO.2015.62.6606. [Epub ahead of print]
International Atomic Energy Agency Randomized Phase III Study of Radiation Therapy in Elderly and/or Frail Patients With Newly Diagnosed Glioblastoma Multiforme.
Roa W1, Kepka L2, Kumar N2, Sinaika V 2, Matiello J2, Lomidze D2, Hentati D2, Guedes de Castro D2, Dyttus-Cebulok K2, Drodge S 2, Ghosh S2, Jeremi? B2, Rosenblatt E2, Fidarova E2.
 
Author information:
1Wilson Roa, Suzanne Drodge, and Sunita Ghosh, University of Alberta, Alberta Health Services-Cancer Control, Edmonton, Alberta, Canada; Lucyna Kepka, Warmia and Mazury Oncology Center, Olsztyn; Katarzyna Dyttus-Cebulok, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland; Narendra Kumar, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Valery Sinaika, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus; Juliana Matiello, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Douglas Guedes de Castro, Castro DG, AC Camargo Cancer Center, São Paulo, Brazil; Darejan Lomidze, High Technology Medical Center, University Clinic, Tbilisi, Georgia; Dalenda Hentati, Institut National de Cancer Salah Azaiz, Ministère de la Santé Publique, Bab Saadoum, Tunisia; Branislav Jeremi?, Institute of Lung Diseases, Institutski put 4, Sremska Kamenica, Serbia; and Eduardo Rosenblatt and Elena Fidarova, International Atomic Energy Agency, Vienna, Austria. wilson.roa@albertahealthservices.ca.
2Wilson Roa, Suzanne Drodge, and Sunita Ghosh, University of Alberta, Alberta Health Services-Cancer Control, Edmonton, Alberta, Canada; Lucyna Kepka, Warmia and Mazury Oncology Center, Olsztyn; Katarzyna Dyttus-Cebulok, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland; Narendra Kumar, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Valery Sinaika, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus; Juliana Matiello, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Douglas Guedes de Castro, Castro DG, AC Camargo Cancer Center, São Paulo, Brazil; Darejan Lomidze, High Technology Medical Center, University Clinic, Tbilisi, Georgia; Dalenda Hentati, Institut National de Cancer Salah Azaiz, Ministère de la Santé Publique, Bab Saadoum, Tunisia; Branislav Jeremi?, Institute of Lung Diseases, Institutski put 4, Sremska Kamenica, Serbia; and Eduardo Rosenblatt and Elena Fidarova, International Atomic Energy Agency, Vienna, Austria.
 
Abstract
PURPOSE:
 
The optimal radiotherapy regimen for elderly and/or frail patients with newly diagnosed glioblastoma remains to be established. This study compared two radiotherapy regimens on the outcome of these patients.
PATIENTS AND METHODS:
 
Between 2010 and 2013, 98 patients (frail = age ≥ 50 years and Karnofsky performance status [KPS] of 50% to 70%; elderly and frail = age ≥ 65 years and KPS of 50% to 70%; elderly = age ≥ 65 years and KPS of 80% to 100%) were prospectively randomly assigned to two arms in a 1:1 ratio, stratified by age (< and ≥ 65 years old), KPS, and extent of surgical resection. Arm 1 received short-course radiotherapy (25 Gy in five daily fractions over 1 week), and arm 2 received commonly used radiotherapy (40 Gy in 15 daily fractions over 3 weeks).
RESULTS:
 
The short-course radiotherapy was noninferior to commonly used radiotherapy. The median overall survival time was 7.9 months (95% CI, 6.3 to 9.6 months) in arm 1 and 6.4 months (95% CI, 5.1 to 7.6 months) in arm 2 (P = .988). Median progression-free survival time was 4.2 months (95% CI, 2.5 to 5.9) in arm 1 and 4.2 months (95% CI, 2.6 to 5.7) in arm B (P = .716). With a median follow-up time of 6.3 months, the quality of life between both arms at 4 weeks after treatment and 8 weeks after treatment was not different.
CONCLUSION:
 
There were no differences in overall survival time, progression-free survival time, and quality of life between patients receiving the two radiotherapy regimens. In view of the reduced treatment time, the short 1-week radiotherapy regimen may be recommended as a treatment option for elderly and/or frail patients with newly diagnosed glioblastoma.
 
© 2015 by American Society of Clinical Oncology.
PMID: 26392096 [PubMed - as supplied by publisher]

 


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