A prospective study of short course radiotherapy in elderly patients with malignant glioma
Elderly patients with malignant glioma have a poorprognosis and the benefit of standard radical radiotherapyis equivocal. Twenty-two percent of the adult referralbase with malignant glioma at our centre isof age 70 years or greater. A phaseII study was undertaken to determine if ashorter course of therapy yields a comparable mediansurvival to radical radiotherapy and thus constitutes anappropriate investigational palliative regimen.25 patients were accrued between 1988–1995, all ofwhom had histologically proven malignant glioma, 23 glioblastomamultiforme and 2 anaplastic astrocytoma. The median agewas 73 (range 70–78) and median Karnofsky PerformanceStatus (KPS) was 70. 40% had a stereotacticbiopsy only for diagnosis. Radiotherapy was delivered tolimited fields to a dose of 37.5 Gyin 15 daily fractions over 3 weeks. Anintention-to-treat analysis was undertaken with survival determined fromdate of initial consultation. The median survival ofthe whole group was 8.0 months (95% CI4.8–9.6). Patients with good performance status (KPS >70) had a median survival of 10.4 months(95% CI 9.6–14.7).37.5 Gy in 15 daily fractions appears toyield comparable median survival to that of otherseries of radical radiotherapy. A phase III studyof this regimen is recommended in investigating optimalpalliation of elderly malignant glioma patients.