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Background <p>Glioblastoma is the most common and aggressive primary brain tumor in adults, with elderly patients facing particularly poor outcomes due to frailty and treatment intolerance. Short-course radiotherapy (SCRT) is a pragmatic approach, but the added benefit of temozolomide (TMZ) to SCRT is supported by limited evidence.</p> Methods <p>We conducted a search of PubMed, SCOPUS and Embase for studies published from inception to July 9, 2025. Eligible studies directly compared SCRT to SCRT + TMZ in elderly adults (≥ 65years) with newly diagnosed, histologically confirmed glioblastoma, and provided Kaplan–Meier survival curves for overall survival (OS) or progression-free survival (PFS). Pseudo-individual patient data were digitized from published survival curves and survival curves were reconstructed. Hazard ratios (HRs) were estimated with a one stage Cox regression analyses and differences in restricted mean survival time (ΔRMST) were analyzed.</p> Results <p>Initial search yielded 211 articles, out of which five studies (1,062 patients; 516 SCRT + TMZ, 546 SCRT) met inclusion for analysis. Mean age was 71.5 years with 53.2% of patients having Karnofsky Performance Status &lt; 80. SCRT + TMZ significantly reduced the hazard of death (HR: 0.68, 95% CI: 0.70–0.77; <i>p</i> &lt; 0.0001) and disease progression (HR 0.53, 95% CI 0.45–0.62, <i>p</i> &lt; 0.0001). The median OS was longer with SCRT + TMZ than with SCRT alone (8.0 months vs. 6.1 months), as was the median PFS (5.1 months vs. 3.8 months). SCRT + TMZ showed increasing survival benefits with significant ΔRMST for OS of up to + 2.50 months at 30 months (95% CI: 1.74–3.31). PFS gains were also significant, with ΔRMST of up to + 1.58 months (95% CI: 1.16–2.01) at 10 months.</p> Conclusion <p>In elderly patients with newly diagnosed glioblastoma, SCRT + TMZ significantly improves OS and PFS compared with SCRT alone with increasing survival benefits over time. There is the need for more clinical trials to supplement the available evidence.</p>

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Short-course radiotherapy with or without temozolomide in elderly patients with newly diagnosed glioblastoma: a time-to-event meta-analysis of overall and progression-free survival

  • 期刊论文

  • 发表日期：

    2025年11月27日

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  • Kwadwo Darko,
  • Jianan Chen,
  • Jeanette E. Eckel-Passow,
  • Ekokobe Fonkem,
  • Susan Geyer,
  • Arnold B. Etame

摘要

Background

Glioblastoma is the most common and aggressive primary brain tumor in adults, with elderly patients facing particularly poor outcomes due to frailty and treatment intolerance. Short-course radiotherapy (SCRT) is a pragmatic approach, but the added benefit of temozolomide (TMZ) to SCRT is supported by limited evidence.

Methods

We conducted a search of PubMed, SCOPUS and Embase for studies published from inception to July 9, 2025. Eligible studies directly compared SCRT to SCRT + TMZ in elderly adults (≥ 65years) with newly diagnosed, histologically confirmed glioblastoma, and provided Kaplan–Meier survival curves for overall survival (OS) or progression-free survival (PFS). Pseudo-individual patient data were digitized from published survival curves and survival curves were reconstructed. Hazard ratios (HRs) were estimated with a one stage Cox regression analyses and differences in restricted mean survival time (ΔRMST) were analyzed.

Results

Initial search yielded 211 articles, out of which five studies (1,062 patients; 516 SCRT + TMZ, 546 SCRT) met inclusion for analysis. Mean age was 71.5 years with 53.2% of patients having Karnofsky Performance Status < 80. SCRT + TMZ significantly reduced the hazard of death (HR: 0.68, 95% CI: 0.70–0.77; p < 0.0001) and disease progression (HR 0.53, 95% CI 0.45–0.62, p < 0.0001). The median OS was longer with SCRT + TMZ than with SCRT alone (8.0 months vs. 6.1 months), as was the median PFS (5.1 months vs. 3.8 months). SCRT + TMZ showed increasing survival benefits with significant ΔRMST for OS of up to + 2.50 months at 30 months (95% CI: 1.74–3.31). PFS gains were also significant, with ΔRMST of up to + 1.58 months (95% CI: 1.16–2.01) at 10 months.

Conclusion

In elderly patients with newly diagnosed glioblastoma, SCRT + TMZ significantly improves OS and PFS compared with SCRT alone with increasing survival benefits over time. There is the need for more clinical trials to supplement the available evidence.