Accelerated fractionation radiotherapy for hospitalized glioblastoma multiforme patients with poor prognostic factors

Abstract

The standard 6 week course of post-operative radiotherapy for glioblastoma multiforme (astrocytoma grade IV) is lengthy, considering the poor prognosis. The standard schedule is especially unsuitable for hospitalized patients and for those with poor prognostic factors (such as old age and poor performance status) since their survival is particularly short. In order to improve the survival-treatment time ratio, we entered a total of 14 hospitalized patients with glioblastoma multiforme (GBM) and poor prognostic factors (mean age 62, mean KPS 57%) into a Phase I trial of accelerated fractionation (AF) external beam radiotherapy. A total tumor dose of 5400-5500 cGy was given in 3 weeks: 4300-4500 cGy whole brain using 100 cGy tid fractions on weekdays plus a 900-1200 cGy boost using single daily fractions of 150-200 cGy on weekends. Only one patient entered did not complete therapy, due to the development of pulmonary embolism resulting in death. Mean survival for all 14 patients from the time of surgical diagnosis was 30.4 weeks. The schedule was well tolerated and resulted in a substantial decrease in treatment time compared to conventional fractionation in these patients. AF schedules should continue to be explored since they may be more appropriate than conventional fractionation schedules for GBM patients with poor prognostic factors, particularly when hospitalized.

Factors associated with survival for patients with glioblastoma with poor pre-operative functional status

“…25,26 Patients with poor function are often withheld aggressive chemotherapeutic regimens. 6–8,15,19,27 The present study shows that poor functioning patients with GB may also have improved survival similar to their higher functioning counterparts.…”

Treatment outcomes for patients with glioblastoma multiforme and a low Karnofsky Performance Scale score on presentation to a tertiary care institution

“…2,8,13,17 The lack of outcome information is particularly notable for the large number of patients with low KPS scores who are also older than 70 years of age. Although a number of studies have included patients with KPS scores ≤ 50, 6,11,13,17,24 only one study to date has documented outcome data separately for such patients. 2 That study showed a benefit from radiotherapy in these patients and suggested that a short palliative course of the treatment led to an outcome equivalent to that obtained with a longer course.…”

“…The few studies that have included patients with a low functional status have usually included them as a minority and have not presented their outcomes in a separate analysis. 11,24 A meta-analysis of three RTOG trials from 1974 to 1989 by Curran et al, 8 for example, showed that 27% of the included patients had KPS scores below 70. However, this group excluded patients older than 70 years of age, despite the fact that older patients make up a significant proportion of those presenting with low KPS scores.…”

Brain Tumors in the Older Person

“…[2][3][4][5][6] Between 1973 and 1985, there has been a dramatic age-specific increase in the incidence of brain tumors. 2 The average annual percentage increases in primary brain tumor incidence for ages [75][76][77][78][79][80][81][82][83][84], and 85 and older were 7%, 20.4%, and 23.4%, respectively. [5][6][7][8] Since 1970, the incidence of primary brain tumors in people over the age of 70 has increased sevenfold.…”