Comparative outcomes of short-term and long-term fractionation with temozolomide in older glioblastoma patients: Single-center experience

Background: The main goal of our study is to comparatively evaluate outcomes of hypofractionation and long-term fractionation with temozolomide (TMZ) in glioblastoma patients older than 65 years. Methods: Eighty patients with glioblastoma meeting the eligibility criteria of >65 years of age, the Karnofsky performance score (KPS) >60, no previous radiotherapy (RT) to the brain referred to our department between October 2009 and October 2016 for adjuvant chemoradiotherapy after surgery were studied. The first group of patients received a dose of 6000 cGy in 30 fractions and the second group was delivered 4000 cGy in 15 fractions All patients used TMZ concomitantly with RT. We used the paired t-test and the Wilcoxon signed-rank test with Statistical Package for the Social Sciences, version 15.0 (SPSS, Inc., Chicago, IL, USA) software for statistical analysis. Results: Forty-six patients were men (57.5%), and 34 patients (42.5%) were woman. Median age was 68 years (range 66-87). Median KPS was 75 (range 60-100). Median follow-up time was 12 months (range 6-30). Median overall survival was 15.2 months and 14.3 months for patients with hypofractionation and conventional fractionation, respectively, with no statistical significance (P = 0.13). Conclusion: Hypofractionation should be recommended to the elderly glioblastoma patients older than 65 years because of the short treatment time, reduced acute adverse effects of both TMZ and RT compared to long-term fractionation.