Background and aim: the study aimed to determine whether hypofractionated radiotherapy (HFRT) with
simultaneous and adjuvant temozolomide (TMZ) was feasible and could provide adequate disease control
in primary GBM patients with poor prognostic factors including large tumor size, poor performance status,
unresectable or multifocal lesions, poor imaging and inflammatory indices. Patients and methods: A
total of 93 patients with glioblastoma multiforme were collected and distributed randomly as 1:1.7 of
cases to controls; cases or arm (I) received HFRT with 45 Gy in 15 fractions over 3 weeks concurrently
with TMZ. Controls or arm (II) received standard conventional fractionation radiotherapy of 60 Gy in 30
fractions over 6 weeks concurrently with TMZ. Results: 35 patients were recruited in arm I while 58
patients in arm II with significant difference in site of GBM, pattern of enhancement, type of surgery,
and neutrophil to lymphocyte ratio, while no significant differences in tumor size, focality, responses,
progression free survival, and overall survival (OS), only the type of surgery was an independent predictor
for OS, no significant difference in the type and degree of toxicity between both arms. Conclusion: Our
results showed that HFRT with concurrent TMZ is a feasible therapeutic approach in patients with GBM,
especially those with poor prognostic factors, assuring high treatment compliance and low toxicity rates.
Dose escalation and reduction in overall treatment time are clear advantages of HFRT, while at least the
same survival rates as conventional fractionated RT are maintained.