Radiotherapy for malignant gliomas in the elderly

While fractionated external beam radiotherapy remains the principal treatment in patients with histologically verified malignant glioma, its use in older patients and in patients with adverse prognostic features has not been subject to randomized studies. Hypofractionated partial brain irradiation offers a short, well-tolerated treatment with a palliative benefit for patients with a predicted median survival of less than 6 months. To assess its true efficacy in terms of survival and quality-of-life gain requires a formal randomized comparison with supportive care either alone or in combination with palliative chemotherapy and with radical radiotherapy. On present evidence, palliative radiotherapy remains the appropriate treatment for older patients and those with adverse prognostic features, but the final choice should be based on the patient’s wishes moderated by the clinician’s perception of the gain of treatment

Hypofractionated radiotherapy for poor prognosis malignant glioma: matched pair survival analysis with MRC controls

Purpose: To assess the survival benefit of palliative hypofractionated radiotherapy in patients with poor prognosis high grade glioma by a matched comparison to conventionally treated controls. Method: Ninety-two elderly and/or disabled patients with high grade glioma with poor prognostic features received palliative partial brain radiotherapy to a dose of 30Gy in six fractions over 2 weeks. Patients were matched for WHO histological grade, performance status and age from a cohort of patients treated with conventionally fractionated radiotherapy to a dose of 60Gy in 30 fractions in an Medical Research Council (MRC) BR05 trial. Results: Patients treated with hypofractionated radiotherapy had a median survival of 5 months with a 1-year survival rate of 12% from diagnosis. The median survival of case-matched controls was estimated to be 2.5–4.5 months longer. Following hypofractionated radiotherapy, Barthel score was improved or remained stable in 68% of patients. Conclusion: Hypofractionated partial brain radiotherapy is a well-tolerated regimen with palliative benefit. Comparison with matched controls suggests lesser survival benefit than would be obtained with radical radiotherapy. However, this is compensated by lower intensity and duration of irradiation induced side effects. It is postulated that there may not be a significant difference in good quality survival or ‘quality adjusted survival’ between the two regimens and this requires testing in prospective trials