Hypofractionated short‐course radiotherapy in elderly patients with glioblastoma multiforme: an analysis of the National Cancer Database

Abstract

For elderly patients with glioblastoma multiforme (GBM), randomized trials have shown similar survival with hypofractionated short‐course radiotherapy (SCRT) compared to conventionally fractionated long‐course radiotherapy (LCRT). We evaluated the adoption of SCRT along with associated factors and survival in a national patient registry. Using the National Cancer Data Base (NCDB), we identified patients aged ≥70 years with GBM, diagnosed between 1998 and 2011, who received SCRT (34–42 Gy in 2.5–3.4 Gy fractions), or LCRT (58–63 Gy in 1.8–2.0 Gy fractions). Crude and adjusted hazard ratios (HR) were calculated using Cox regression modeling. 4598 patients were identified, 304 (6.6%) in the SCRT group and 4294 (93.4%) in the LCRT group. Median follow‐up was 8.4 months. Median age was 78 versus 75 years, respectively (P < 0.0001). Patients who received SCRT had higher Charlson–Deyo comorbidity scores versus LCRT (score of ≥2: 16.9% vs. 10.8%, respectively; P = 0.006), and were more likely to be female (53.0% vs. 44.6%, P = 0.005). Patients who received SCRT were less likely to undergo chemotherapy (42.8% vs. 79.3%, P < 0.0001), more likely to undergo biopsy only (34.5% vs. 19.5%, P < 0.0001), and more likely to receive treatment at academic/research programs (49.2% vs. 37.2%, P = 0.0001). Median survival was 4.9 months versus 8.9 months, respectively (P < 0.0001). The survival detriment with SCRT persisted on multivariable analysis [HR 1.51 (95% CI: 1.33–1.73, P < 0.0001)], adjusting for age, gender, race, comorbidities, diagnosis year, facility type, surgery, and chemotherapy. In conclusion, hypofractionated SCRT was associated with worse survival compared to conventionally fractionated LCRT for elderly patients with GBM. Patients who received SCRT were older with worse comorbidities, and were less likely to undergo chemotherapy or resection.

The Association of Treatment Facility Type With the Survival of Brain Metastases Patients Regardless of the Primary Site Cancer

“…The results of the current study are consistent with the ndings of other studies in various cancers [25][26][27][28] .…”

“…A study of glioblastoma patients who received chemoradiation therapy after surgical resection or biopsy reported improved OS for patients treated at academic facility compared to patients treated at community hospitals (HR: 0.86, CI: 0.82-0.91) 27 . Receiving treatment at an academic hospital was associated with improved OS in a study of patients age ≥ 70 diagnosed with glioblastoma (HR: 0.76, CI: 0.66-0.86) compared to receiving treatment at non-academic facilities 26 for patients diagnosed with BMs from NSCLC 23 . In our study, academic centers were more likely to use chemotherapy (56% vs. 53%) and RT (74% vs. 71%) compared to non-academic centers.…”

“…In this study, patients with Medicaid and patients from low-income areas were less likely to receive treatment at academic centers 25 . Few studies of the Glioblastoma patients who underwent surgery reported improved OS for patients treated at academic centers compared to community treatment centers [26][27][28] . Better OS associated with receiving treatment at academic facilities has also been reported in resectable pancreatic cancer, intrahepatic cholangiocarcinoma, and metastatic NSCLC 29-31 . Due to the complex treatment modalities and expertise needed for the treatments of BMs patients, the impact of academic or research treatment facilities on the OS of BMs patients must be investigated.…”

Trends and disparities in the utilization of hypofractionated neoadjuvant radiation therapy for rectal cancer in the United States

“…Monetary and socioeconomic aspects of oncologic and radiotherapeutic care are easily apparent from these data, which are crucial to consider in the pursuit of equalopportunity care in the United States going forward. Owing to monetary/billing issues, community and private practices are well-documented to offer conventional fractionation for many neoplasms for which there is level I evidence for hypofractionation (15)(16)(17), and herein we demonstrate a similar situation for RC cases. Further proving these points were the findings that patients with private insurance and higher incomes were more likely to receive CFRT, likely related to the "fee-for-service" billing model widely in effect in the United States.…”

Radiotherapy and COVID-19 pandemic - a review of the current recommendations

“…In the literature, the data of the overall survival (OS) among elderly patients who were treated with standard and hypofractionated RT are different. Mak et al found that patients treated with hypofractionation radiotherapy had worse OS than the others with standard course RT [9]. On the other side, Row et al found that there were no difference in OS among the groups [10].…”