BACKGROUND: Glioblastoma multiforme (GBM) is a fatal brain malignancy 
with grave prognosis despite advances in treatment, with median overall 
survival still dismal, which is worst in elderly and frail patients
PURPOSE: To evaluate progression free and Overall survival outcomes in 
elderly (aged 60 and above) or frail patients with glioblastoma multiforme 
(GBM) in a pilot retrospective study comparing two short-course radiation 
therapy fractionations.
METHODS AND MATERIALS: Retrospective two arm study. Elderly (60 
years and above) and /or frail patients (with ECOG 3) with a diagnosis of GBM 
were studied and reviewed. Total 76 patients were reviewed into one of two 
arms; Arm A: short-course RT (25 Gy in five fractions 5 Gy per fraction daily 
over a week) or arm B using 40 Gy in 15 fractions over 3 weeks 2.667 Gy per 
fraction. Treatment planning was either 3D conformal planning or intensity 
modulated radiotherapy (IMRT). Patients were analysed for progression free 
survival (PFS) and overall survival (OS) according to age, Eastern Cooperative 
Oncology Group (ECOG) Performance Status (KPS), and extent of surgery. For 
patients received concurrent chemotherapy tamozolamide 75 mg / m2 dose was 
used. Ethical committee approval was obtained.
RESULTS: Median follow up period was 9.02 months (range: 3-16). 
Concurrent and adjuvant chemotherapy was given among 28/51 patients 
(54.9%) treated with 40 Gy in 15 fractions. 
The 25 Gy/5 fractions/ 1 week RT (25 patients) was better tolerated with less 
use of post treatment steroid use (28% vs 35.3% in arm B). The median OS time 
was 7.5 months (95% CI, 6.7-8.4 months) in arm A versus 9.7 months (95% CI, 
8.9-10.6 months) in arm B (P=.0001). 
Median PFS and OS rates of whole cohort were 7.0 months and 9.0 months in 
arm A and arm B respectively. However, the median PFS was 5.4 months (95% 
confidence interval [CI], 4.8-6.5 months) in the five fractions (arm A) and 7.9 
months (95% CI, 7.2-8.6 months) in 40 Gy/15 fx/3weeks (arm B) (P=.0.0001). 
CONCLUSIONS: A short-course RT regimen of 25 Gy in 5 fractions over a 
week was found inferior treatment option for elderly or frail patients with GBM 
as compared to 40 Gy in 15 fractions/ 3 weeks. This May be due to poor 
Performance of the patients assigned to the shorter arm of five fractions. Further 
prospective studies with larger numbers are needed.