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Short-Course Radiation plus Temozolomide in Elderly Patients with Glioblastoma. 2017
James R Perry, and
Normand Laperriere, and
Christopher J O'Callaghan, and
Alba A Brandes, and
Johan Menten, and
Claire Phillips, and
Michael Fay, and
Ryo Nishikawa, and
J Gregory Cairncross, and
Wilson Roa, and
David Osoba, and
John P Rossiter, and
Arjun Sahgal, and
Hal Hirte, and
Florence Laigle-Donadey, and
Enrico Franceschi, and
Olivier Chinot, and
Vassilis Golfinopoulos, and
Laura Fariselli, and
Antje Wick, and
Loic Feuvret, and
Michael Back, and
Michael Tills, and
Chad Winch, and
Brigitta G Baumert, and
Wolfgang Wick, and
Keyue Ding, and
Warren P Mason, and
From Odette Cancer Centre, Sunnybrook Health Sciences Centre (J.R.P., A.S.) and Princess Margaret Cancer Centre (N.L., W.P.M.), Toronto, the Canadian Cancer Trials Group, Queens University, Kingston, ON (C.J.O., C.W., K.D.), University of Calgary, Calgary, AB (J.G.C.), University of Alberta, Edmonton (W.R.), Quality of Life Consulting, West Vancouver, BC (D.O.), Queen's University, Kingston General Hospital, Kingston, ON (J.P.R.), and Juravinski Cancer Centre, Hamilton, ON (H.H.) - all in Canada; Azienda Unità Sanitaria Locale- Istituto di Ricovero e Cura a Carattere Scientifico Istituto delle Scienze Neurologiche, Bologna (A.A.B., E.F.), and Fondazione Istituto Neurologico Carlo Besta, Milan (L. Fariselli) - both in Italy; University Hospital Gasthuisberg, Leuven, Belgium (J.M.); Peter MacCallum Cancer Centre, Melbourne, VIC (C.P.), University of Newcastle, Newcastle, NSW (M.F.), University of Queensland, Brisbane (M.F.), and Royal North Shore Hospital, Sydney (M.B.) - all in Australia; Saitama Medical University International Medical Center, Saitama, Japan (R.N.); Hôpital de la Pitié-Salpêtrière (F.L.-D., L. Feuvret), Paris, and Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire Timone, Marseilles (O.C.) - both in France; the European Organization for Research and Treatment of Cancer, Brussels (V.G.); the Neurology Clinic, University of Heidelberg, Heidelberg, Germany (A.W., W.W.); Tauranga Hospital, Tauranga, New Zealand (M.T.); and Maastricht University Medical Center and School for Oncology and Developmental Biology, Maastricht, the Netherlands (B.G.B.).
Glioblastoma is associated with a poor prognosis in the elderly. Survival has been shown to increase among patients 70 years of age or younger when temozolomide chemotherapy is added to standard radiotherapy (60 Gy over a period of 6 weeks). In elderly patients, more convenient shorter courses of radiotherapy are commonly used, but the benefit of adding temozolomide to a shorter course of radiotherapy is unknown. We conducted a trial involving patients 65 years of age or older with newly diagnosed glioblastoma. Patients were randomly assigned to receive either radiotherapy alone (40 Gy in 15 fractions) or radiotherapy with concomitant and adjuvant temozolomide. A total of 562 patients underwent randomization, 281 to each group. The median age was 73 years (range, 65 to 90). The median overall survival was longer with radiotherapy plus temozolomide than with radiotherapy alone (9.3 months vs. 7.6 months; hazard ratio for death, 0.67; 95% confidence interval [CI], 0.56 to 0.80; P<0.001), as was the median progression-free survival (5.3 months vs. 3.9 months; hazard ratio for disease progression or death, 0.50; 95% CI, 0.41 to 0.60; P<0.001). Among 165 patients with methylated O6-methylguanine-DNA methyltransferase (MGMT) status, the median overall survival was 13.5 months with radiotherapy plus temozolomide and 7.7 months with radiotherapy alone (hazard ratio for death, 0.53; 95% CI, 0.38 to 0.73; P<0.001). Among 189 patients with unmethylated MGMT status, the median overall survival was 10.0 months with radiotherapy plus temozolomide and 7.9 months with radiotherapy alone (hazard ratio for death, 0.75; 95% CI, 0.56 to 1.01; P=0.055; P=0.08 for interaction). Quality of life was similar in the two trial groups. In elderly patients with glioblastoma, the addition of temozolomide to short-course radiotherapy resulted in longer survival than short-course radiotherapy alone. (Funded by the Canadian Cancer Society Research Institute and others; ClinicalTrials.gov number, NCT00482677 .).
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