Tony J C Wang1, Cheng-Chia Wu2, Ashish Jani2, Juan Estrada2, Timothy Ung3, Daniel S Chow4, Jennifer E Soun4, Shumaila Saad2, Yasir H Qureshi5, Robyn Gartrell6, Heva J Saadatmand2, Anurag Saraf2, Matthew D Garrett2, Christopher Grubb2, Steven R Isaacson7, Simon K Cheng8, Michael B Sisti9, Jeffrey N Bruce9, Sameer A Sheth9, Andrew B Lassman10, Fabio M Iwamoto10, Guy M McKhann9. 1. Department of Radiation Oncology, Columbia University Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York. Electronic address: tjw2117@cumc.columbia.edu. 2. Department of Radiation Oncology, Columbia University Medical Center, New York, New York. 3. Department of Neurological Surgery, Columbia University Medical Center, New York, New York. 4. Department of Radiology, Columbia University Medical Center, New York, New York. 5. The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York. 6. Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York. 7. Department of Radiation Oncology, Columbia University Medical Center, New York, New York; Department of Neurological Surgery, Columbia University Medical Center, New York, New York. 8. Department of Radiation Oncology, Columbia University Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York. 9. Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Department of Neurological Surgery, Columbia University Medical Center, New York, New York. 10. Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Department of Neurology, Columbia University Medical Center, New York, New York.
Abstract
PURPOSE: Adjuvant hypofractionated radiation therapy (HRT) for elderly patients with newly diagnosed glioblastoma (GBM) is a reasonable option compared with standard fractionation radiation therapy (SFRT). Outcomes in patients receiving HRT in the presence of temozolomide (TMZ) compared with SFRT with TMZ are unclear. We examined HRT for GBM with TMZ in comparison to SFRT with TMZ. METHODS AND MATERIALS: We conducted a retrospective analysis of patients ≥60 years of age with newly diagnosed GBM who received SFRT or HRT from 1994 to 2014 in the postoperative setting. Inclusion criteria included SFRT (60 Gy/30 fractions or 59.4 Gy/33 fractions) versus HRT (40 Gy/15 fractions). RESULTS: In this cohort, 158 patients were treated with SFRT versus 26 with HRT. Median survival in patients receiving SFRT compared with HRT was 430 and 475 days (P = .550), respectively. Ninety-five percent of the SFRT patients received TMZ versus 100% of those treated with HRT. Patients receiving HRT were older (median, 72 vs 66 years). All HRT patients were treated with the intensity modulated radiation therapy (IMRT) technique versus SFRT, in which 57% had IMRT. Multivariate Cox regression showed decreased overall survival (OS) associated with patient age >70 (hazard ratio [HR], 1.84), lower Karnofsky performance status (HR, 5.25), biopsy versus surgical resection (HR, 4.18), radiation therapy planning technique 3- or 2-dimensional planning versus IMRT (HR, 1.91; HR, 3.40, respectively). Analysis restricted to patients receiving IMRT-based planning showed no difference in OS between HRT and SFRT. For patients receiving TMZ, there was no survival difference between those treated with HRT and those treated with SFRT. CONCLUSIONS: Elderly GBM patients receiving HRT and those receiving SFRT had similar OS. Subset analysis patients receiving concurrent TMZ showed no difference in OS between the HRT and SFRT groups.
PURPOSE: Adjuvant hypofractionated radiation therapy (HRT) for elderly patients with newly diagnosed glioblastoma (GBM) is a reasonable option compared with standard fractionation radiation therapy (SFRT). Outcomes in patients receiving HRT in the presence of temozolomide (TMZ) compared with SFRT with TMZ are unclear. We examined HRT for GBM with TMZ in comparison to SFRT with TMZ. METHODS AND MATERIALS: We conducted a retrospective analysis of patients ≥60 years of age with newly diagnosed GBM who received SFRT or HRT from 1994 to 2014 in the postoperative setting. Inclusion criteria included SFRT (60 Gy/30 fractions or 59.4 Gy/33 fractions) versus HRT (40 Gy/15 fractions). RESULTS: In this cohort, 158 patients were treated with SFRT versus 26 with HRT. Median survival in patients receiving SFRT compared with HRT was 430 and 475 days (P = .550), respectively. Ninety-five percent of the SFRT patients received TMZ versus 100% of those treated with HRT. Patients receiving HRT were older (median, 72 vs 66 years). All HRT patients were treated with the intensity modulated radiation therapy (IMRT) technique versus SFRT, in which 57% had IMRT. Multivariate Cox regression showed decreased overall survival (OS) associated with patient age >70 (hazard ratio [HR], 1.84), lower Karnofsky performance status (HR, 5.25), biopsy versus surgical resection (HR, 4.18), radiation therapy planning technique 3- or 2-dimensional planning versus IMRT (HR, 1.91; HR, 3.40, respectively). Analysis restricted to patients receiving IMRT-based planning showed no difference in OS between HRT and SFRT. For patients receiving TMZ, there was no survival difference between those treated with HRT and those treated with SFRT. CONCLUSIONS: Elderly GBM patients receiving HRT and those receiving SFRT had similar OS. Subset analysis patients receiving concurrent TMZ showed no difference in OS between the HRT and SFRT groups.
Authors: Jessica W Lee; John P Kirkpatrick; Frances McSherry; James E Herndon; Eric S Lipp; Annick Desjardins; Dina M Randazzo; Henry S Friedman; David M Ashley; Katherine B Peters; Margaret O Johnson Journal: Front Oncol Date: 2021-02-25 Impact factor: 6.244
Authors: Matthew D Garrett; Ted K Yanagihara; Randy Yeh; Guy M McKhann; Michael B Sisti; Jeffrey N Bruce; Sameer A Sheth; Adam M Sonabend; Tony J C Wang Journal: Tomography Date: 2017-09
Authors: Md Yousuf Ali; Claudia R Oliva; Abu Shadat M Noman; Bryan G Allen; Prabhat C Goswami; Yousef Zakharia; Varun Monga; Douglas R Spitz; John M Buatti; Corinne E Griguer Journal: Cancers (Basel) Date: 2020-09-03 Impact factor: 6.639