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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, P.
Forsyth
From the
Cross Cancer Institute; Division of Epidemiology, Prevention and Screening,
Alberta Cancer Board; Departments of Oncology, Laboratory Medicine and
Pathology, and Surgery, University of Alberta, Edmonton; Departments of Oncology
and Clinical Neurosciences, University of Calgary and Tom Baker Cancer Center,
Calgary, Alberta; London Regional Cancer Center, London; Northwestern Regional
Cancer Center, Thunder Bay, Ontario, Canada; and M.D. Anderson Cancer Center,
Houston, TX.
Address
reprint requests to Wilson Roa, MD, Cross Cancer Institute, 11560 University
Ave, Edmonton, Alberta, Canada T6G 1Z2; e-mail: wilsonro@cancerboard.ab.ca
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 (χ2
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.
This
project was supported by the Research Initiative Program of the
Alberta Cancer Board.
This study was presented in part on February 7 and 8, 2003, at the
Canadian Brain Tumor Consortium Investigator's Meeting, Lake Louise,
Alberta, Canada.
© 2004
American
Society for Clinical Oncology
Source: http://www.jco.org/cgi/content/abstract/22/9/1583
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