Survival Outcomes with Short-Course Radiotherapy in Elderly Patients with Glioblastoma : Data from a Randomized Phase III Trial
A partir des données d'un essai multicentrique de phase III portant sur 235 patients âgés atteints d'un glioblastome (âge médian : 72 ans), cette étude compare, du point de vue de la survie sans progression et de la survie globale, l'efficacité de deux protocoles de radiothérapie de courte durée
Purpose : To perform a subset analysis of survival outcomes in elderly patients with glioblastoma (GBM) from a randomized phase III trial comparing two short-course radiotherapy (RT) regimens in elderly and/or frail patients. Methods and Materials : The original trial population included elderly and/or frail patients diagnosed with GBM. Patients joined the phase III, randomized, multicenter, prospective, non-inferiority trial and were assigned to one of two groups in a 1:1 ratio to either short-course RT (25 Gy in 5 fractions, arm 1) or commonly used RT (40 Gy in 15 fractions, arm 2) and stratified by age (< and ≥ 65 years), Karnofsky performance status, and extent of surgery. For the subset analysis in this study, only patients ≥ 65 years were evaluated (elderly and frail patients were defined as age ≥ 65 years and KPS 50-70%; elderly and not frail patients were defined as age ≥ 65 years and KPS 80-100%), resulting in 61 out of 98 initial patients, with 26 patients randomized to arm 1 and 35 to arm 2. Results : In this unplanned analysis, the short-course RT results were not statistically significant different to commonly used RT in elderly patients. The median overall survival time was 6.8 months (95% CI, 4.5 to 9.1 months) in arm 1 and 6.2 months (95% CI, 4.7 to 7.7 months) in arm 2 (P = 0.936). Median progression-free survival time was 4.3 months (95% CI, 2.6 to 5.9 months) in arm 1 and 3.2 months (95% CI, .1 to 6.3 months) in arm 2 (P = 0.706). Conclusions : A short-course RT regimen of 25 Gy in 5 fractions is an acceptable treatment option for patients over 65 years old, mainly for those with poor performance or contraindication to chemotherapy, which would be indicated in cases of methylated MGMT promoted tumors.
http://www.redjournal.org/article/S0360-3016(17)30738-1/fulltext