Hypofractionated radiation therapy versus standard fractionated radiation therapy with concurrent temozolomide in elderly patients with newly diagnosed glioblastoma

Wang, Tony J. C.; Wu, Cheng‐Chia; Jani, Ashish; Estrada, Juan; Ung, Timothy H.; Chow, Daniel; Soun, Jennifer E.; Saad, S.; Qureshi, Yasir H.; Gartrell, Robyn D.; Saadatmand, Heva J.; Saraf, Anurag; Garrett, Matthew D.; Grubb, Christopher S.; Isaacson, Steven R.; Cheng, Simon K.; Sisti, Michael B.; Bruce, Jeffrey N.; Sheth, Sameer A.; Lassman, Andrew B.; Iwamoto, Fábio M.; McKhann, Guy M.

doi:10.1016/j.prro.2015.12.001

Cited by 17 publications

(9 citation statements)

References 15 publications

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“…A hypofractionated protocol, consisting of 2.67 Gy per fraction for total dose of 40 Gy over 3 weeks, was prescribed to 12 patients. The hypofractionated protocol was reserved for elderly patients given its shorter treatment period; in accordance with other published data, an earlier study evaluating outcomes of patients at our own institution yielded no significant difference in OS between standard and hypofractionated treatment regimens when adjusted for age and concomitant chemotherapy ( 16 ).…”

Section: Methodssupporting

confidence: 68%

Monitoring Radiation Treatment Effects in Glioblastoma: FLAIR Volume as Significant Predictor of Survival

et al. 2017

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Glioblastoma is the most common adult central nervous system malignancy and carries a poor prognosis. Disease progression and recurrence after chemoradiotherapy are assessed via serial magnetic resonance imaging sequences. T2-weighted fluid-attenuated inversion recovery (FLAIR) signal is presumed to represent edema containing microscopic cancer infiltration. Here we assessed the prognostic impact of computerized volumetry of FLAIR signal in the peri-treatment setting for glioblastoma. We analyzed pre- and posttreatment FLAIR sequences of 40 patients treated at the Columbia University Medical Center between 2011 and 2014, excluding those without high-quality FLAIR imaging within 2 weeks before treatment and 60 to 180 days afterward. We manually contoured regions of FLAIR hyperintensity as per Radiation Therapy Oncology Group guidelines and calculated the volumes of nonenhancing tumor burden. At the time of this study, all but 1 patient had died. Pre- and posttreatment FLAIR volumes were assessed for correlation to overall and progression-free survival. Larger post-treatment FLAIR volumes from sequences taken between 60 and 180 days after conclusion of chemoradiotherapy were negatively correlated with overall survival (P = .048 on Pearson's correlation and P = .017 and P = .043 on univariable and multivariable Cox regression analyses, respectively) and progression-free survival (P = .002 on Pearson's correlation and P = < .001 and P = < .001 on univariable and multivariable Cox regression analyses). This study suggests that higher FLAIR volumes in the 2- to 6-month posttreatment window are associated with worsened survival.

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Section: Methodssupporting

confidence: 68%

Monitoring Radiation Treatment Effects in Glioblastoma: FLAIR Volume as Significant Predictor of Survival

et al. 2017

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“…The RT fractionation used in the present study is a 3-week schedule that represents a reasonable balance between overall treatment time, efficacy and toxicity, with particular regard to early-delayed encephalopathy, which can affect patients in the first 2 months after RT [26]. In a study of 158 patients, Wang et al reported the same conclusions [27]. An additional improvement could be physicians in the selection of patients who may benefit from TMZ.…”

Section: Discussionmentioning

confidence: 58%

Role of irradiation for patients over 80 years old with glioblastoma: a retrospective cohort study

Bracci¹,

Laigle‐Donadey

Hitchcock

et al. 2016

J Neurooncol

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To assess efficacy and safety of hypofractionated radiation therapy (HRT) in patients over 80 years old with newly diagnosed glioblastoma (GBM). Between June 2009 and September 2015, patients in this population with a recommendation for radiation therapy from a multidisciplinary tumor board, and a Karnofsky performance status (KPS) ≥60 as assessed by a radiation oncologist, who received HRT (40 Gy/15 fractions) ± concomitant and adjuvant temozolomide (TMZ) were retrospectively analyzed. A total of 21 patients fulfilled the criteria for eligibility. Median KPS was 80 (60-90). After a median follow-up of 5.8 months (IQR 3.7-13.1 months), median overall survival (OS) was 7.5 months (95 % CI 4.5-19.1) and the 1-year and 2-year OS were 39.5 % (95 % CI 21.9-71.2 %) and 6.6 % (95 % CI 1.0- 43.3 %), respectively. Median progression-free survival (PFS) was 5.8 months (95 % CI 3.9-7.7 months), 1-year and 2-year PFS were 15.2 % (95 % CI 4.4-52.4) and 0 %, respectively. Overall, 16 (76.2 %) patients presented a recurrence. Overall seven patients (33.3 %) needed to be hospitalized during treatment. On univariate analysis, hospitalization was the only variable that correlated with less favourable outcome in terms of both OS (12.2 months versus 3.8 months, p < 0.010) and PFS (5.8 months versus 3.4 months, p = 0.002). Our study suggests that HRT is feasible with acceptable tolerance among "very elderly" patients affected by GBM. Patients 80 and older should be considered for management based on RT.

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“…There is a growing interest for the use of HFRT for glioblastoma in elderly patients, [ 12 – 16 ] and to treat breast cancer, [ 17 – 19 ] and prostate cancer. [ 20 – 24 ] This strategy aims to reduce treatment costs and hospital visits, while providing similar treatment outcomes.…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated radiotherapy versus conventional radiotherapy for diffuse intrinsic pontine glioma

Park

Yea²

2020

Medicine

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Background: The standard treatment for diffuse intrinsic pontine glioma (DIPG) is radiotherapy, although conventional fractionated radiotherapy (CFRT) may not be in the best interest of the patient. Instead, hypofractionated radiotherapy (HFRT) may shorten the treatment period and reduce related costs for this treatment, which is typically palliative in nature. Methods: This systematic review and meta-analysis evaluated survival outcomes among patients who received HFRT or CFRT for DIPG. The PubMed, Medline, EMBASE, Cochrane Central Register, and Scopus databases were searched to identify relevant studies. Overall survival was the primary outcome of interest and progression-free survival was the secondary outcome of interest. Results: The search identified a total of 2376 reports, although only 4 reports were ultimately included in the meta-analysis. The studies included 88 patients who underwent HFRT and 96 patients who underwent CFRT. Relative to CFRT, HFRT provided comparable outcomes in terms of overall survival (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 0.77–1.47) and progression-free survival (HR: 1.04, 95% CI: 0.75–1.45). Conclusions: The results of this meta-analysis suggest that CFRT and HFRT provide similar survival outcomes for patients with DIPG.

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Hypofractionated radiation therapy versus standard fractionated radiation therapy with concurrent temozolomide in elderly patients with newly diagnosed glioblastoma

Cited by 17 publications

References 15 publications

Monitoring Radiation Treatment Effects in Glioblastoma: FLAIR Volume as Significant Predictor of Survival

Monitoring Radiation Treatment Effects in Glioblastoma: FLAIR Volume as Significant Predictor of Survival

Role of irradiation for patients over 80 years old with glioblastoma: a retrospective cohort study

Hypofractionated radiotherapy versus conventional radiotherapy for diffuse intrinsic pontine glioma

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