Short-term radiotherapy followed by adjuvant chemotherapy in poor-prognosis patients with glioblastoma

Roberta Muni, Giuseppe Minniti, Gaetano Lanzetta, Paola Caporello, Alessandro Frati, Maurizio Maurizi Enrici, Paolo Marchetti, Riccardo Maurizi Enrici

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives. The optimal treatment for patients with glioblastoma with unfavorable prognostic factors, such as old age and low performance status, remains controversial. We conducted a prospective study to assess the effect of temozolomide and short-course radiation versus short-course radiation alone in the treatment of poorprognosis patients with newly diagnosed glioblastoma. Patients andmethods. Forty-five patients with a newly diagnosed glioblastoma, older than 70 years or aged 50-70 years and with a Karnofsky performance score ≤70 were enrolled in this prospective study. Twenty-three patients were treated with an abbreviated course of radiotherapy (30 Gy in 6 fractions over 2 weeks) and 22 patients with the same radiotherapy schedule plus adjuvant temozolomide at the dose of 150-200 mg/m2 for 5 days every 28-day cycle. The primary end pointwas overall survival. Secondary end points included progression-free survival and toxicity. Results. Median overall survival was 7.3 months in the radiotherapy group and 9.4 months in the radiotherapy plus temozolomide group (P = 0.003), with respective 6-month overall survivals of 78% and 95%, respectively. Median progression-free survival was 4.4 months in the radiotherapy group and 5.5 months in the radiotherapy plus temozolomide group (P = 0.01), and respective 6-month progression-free survival rates were 22% and 45%. In multivariate analysis, Karnofsky performance score was the only significant independent predictive factor of survival (P = 0.03). Adverse effects of radiotherapy were mainly represented by neurotoxicity (24%), which resolved inmost cases with the use of steroids. Grade 3-4 hematologic toxicity occurred in 36% of patients treated with temozolomide. Conclusions. The addition of temozolomide to short-term radiotherapy resulted in a statistically significant survival benefit withminimal additional toxicity in poor-prognosis patients with newly diagnosed glioblastoma. Future studies need to define the best combined regimens of radiotherapy and temozolomide on survival and quality of life in this subgroup of patients. Free full text available at www.tumorionline.it.

Original languageEnglish
Pages (from-to)60-64
Number of pages5
JournalTumori
Volume96
Issue number1
DOIs
Publication statusPublished - Jan 2010

Keywords

  • Chemotherapy
  • Elderly
  • Glioblastoma
  • Prognostic factors
  • Radiotherapy
  • Temozolomide

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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