PRECISION THROUGH MODERATION: REDEFINING GBM THERAPY IN THE ELDERLY WITH HYPOFRACTIONATED RADIOTHERAPY

Background: Glioblastoma (GBM) is the most aggressive primary brain tumor, with particularly poor prognosis in elderly patients due to age-related comorbidities and reduced treatment tolerance. Standard therapy based on the Stupp protocol is often poorly suited to this population. Hypofractionated radiotherapy (HFRT) has emerged as a promising alternative, but optimal regimens and outcomes remain under investigation. This prospectiv Methods: e single-arm study included 25 patients aged ≥60 years with histologically confirmed GBM and Karnofsky Performance Status (KPS) >50. All patients underwent maximal safe resection followed by HFRT (40.05 Gy in 15 fractions) with concurrent temozolomide (TMZ) and adjuvant TMZ per the Stupp protocol. The primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS), treatment compliance, toxicity, and neurologic outcomes. The median age was 63.7 years. Gross total resection was achieved in 84% of patients. Adju Results: vant TMZ was administered in 76%. Median OS and PFS were 7.99 and 5.69 months, respectively. Extent of resection significantly influenced PFS (p = 0.028), but not OS. Treatment was well tolerated, with no grade 3–4 hematologic toxicity. Posttreatment neurologic improvement was noted in 44% of patients, with stable or improved KPS in 80%. Mild cognitive decline occurred in 20% of patients. HFRT combined with TMZ is a feasible, effective, and well-toler Conclusion: ated treatment option for elderly GBM patients. It provides survival outcomes comparable to conventional regimens with improved tolerability and functional preservation. These findings support HFRT as a standard approach in appropriately selected elderly or frail patients.