Dulal Kiran Mondal
GTR followed by post-op RT with concurrent TMZ followed by adjuvant TMZ is standard of care in GBM. Introduction of TMZ was based on a pivotal study in which patients were mostly 70 years or younger; increasing age was found to be a negative prognostic factor. Efficacy of this adjuvant treatment decreased with advanced age and poor performance status, as they have poor prognosis and do not tolerate this treatment well. In this population, RT alone or RT plus best supportive care or supportive care only or TMZ only tried with varied results. There is always a debate that which of these is better and should be recommended. As radiotherapy comes with the logistic problem of daily visit to hospital, we have reviewed relevant studies to see whether TMZ alone should be recommended to these patients.
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