Hypofractionated chemoradiotherapy with temozolomide as a treatment option for glioblastoma patients with poor prognostic features

Background: Although the optimal treatment of frail glioblastoma patients is still controversial, previous randomized trials have excluded such patients. This study aimed to evaluate the feasibility and safety of hypofractionated radiotherapy (RT) with concomitant temozolomide for glioblastoma patients with poor prognostic features. Methods: We retrospectively reviewed 33 glioblastoma patients who underwent postoperative hypofractionated chemoradiotherapy. The patient criteria were either ≥70 years or <70 years with one or more risk factors: pre-RT performance status (ECOG score) ≥3, biopsy only, or rapid disease progression immediately after surgery. The median RT dose was 45 Gy (range 30–45) with a fraction size of 3 Gy. Results: The median age was 66.0 years. Eighteen patients (55 %) had poor pre-RT performance status (ECOG ≥3), and 16 patients (48 %) underwent stereotactic biopsy only. The median overall survival (OS) and progression-free survival were 10.6 and 7.5 months, respectively. Poor pre- and post-RT performance status [hazard ratio (HR) 3.12, 95 % confidence interval (CI) 1.21–8.07 and HR 4.51, 95 % CI 1.44–14.12, respectively] and no pseudoprogression (HR 5.43, 95 % CI 1.58–18.61) were associated with poorer OS. While acute neurologic symptoms were reported in 5 patients (15 %), toxicity profiles were acceptable without treatment-related aggravation of performance status. Conclusions: Concurrent chemoradiotherapy with temozolomide, the current standard treatment after surgery for glioblastoma, could be shortened without increasing side effects for patients with poor prognostic features.