Concomitant (without adjuvant) temozolomide and radiation to treat glioblastoma: A retrospective study.

Between November 2004 and August 2006 we treated 35 patients with concomitant temozolomide (TMZ) and radiotherapy. Twelve patients had very large or multi-centric glioblastoma multiforme (GBM) with a poor performance status and received TMZ plus radiation doses of 45 to 50.4 Gy. Median survival of these patients was only 3.8 months and any benefit from treatment was small. Twenty three patients would have been eligible for randomisation in the EORTC/NCIC trial comparing combined and adjuvant TMZ plus radiation against radiotherapy alone. This group of patients received 60 Gy in 30 fractions plus comitant TMZ (75mg/m2) but no adjuvant chemotherapy. At a median follow-up of 26 months, 5 out of 23 patients are alive. The median survival time was 17 months (1.43 years 95% CI 0.96 to 1.55 years). 18% were alive at 2 years. Toxicity from temozolomide was infrequent. This series adds to indirect evidence that the concomitant rather than the adjuvant is the most efficacious part of the EORTC/NCIC schedule for this type of patient. Further trials should include a concomitant chemoradiotherapy regimen as well as a concomitant plus adjuvant chemotherapy.