***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: For elderly patients with glioblastoma multiforme ( GBM ) , r and omized trials have shown similar survival with hypofractionated short‐course radiotherapy ( SCRT ) compared to conventionally fractionated long‐course radiotherapy ( LCRT ) . We evaluated the adoption of SCRT along with associated factors and survival in a national patient registry . Using the National Cancer Data Base ( NCDB ) , we identified patients aged ≥70 years with GBM , diagnosed between 1998 and 2011 , who received SCRT ( 34–42 Gy in 2.5–3.4 Gy fractions ) , or LCRT ( 58–63 Gy in 1.8–2.0 Gy fractions ) .  Crude and adjusted hazard ratios ( HR ) were calculated using Cox regression modeling . 4598 patients were identified , 304 ( 6.6 % ) in the SCRT group and 4294 ( 93.4 % ) in the LCRT group .  Median follow‐up was 8.4 months . Median age was 78 versus 75 years , respectively ( P < 0.0001 ) . Patients who received SCRT had higher Charlson – Deyo comorbidity scores versus LCRT ( score of ≥2 : 16.9 % vs. 10.8 % , respectively ; P = 0.006 ) , and were more likely to be female ( 53.0 % vs. 44.6 % , P = 0.005 ) . Patients who received SCRT were less likely to undergo chemotherapy ( 42.8 % vs. 79.3 % , P < 0.0001 ) , more likely to undergo biopsy only ( 34.5 % vs. 19.5 % , P < 0.0001 ) , and more likely to receive treatment at academic/ research programs ( 49.2 % vs. 37.2 % , P = 0.0001 ) . Median survival was 4.9 months versus 8.9 months , respectively ( P < 0.0001 ) . The survival  detriment with SCRT persisted on multivariable analysis [ HR 1.51 ( 95 % CI : 1.33–1.73 , P < 0.0001 ) ] , adjusting for age , gender , race , comorbidities , diagnosis year , facility type , surgery , and chemotherapy . In conclusion , hypofractionated SCRT was associated with worse survival compared to conventionally fractionated LCRT for elderly patients with GBM . Patients who received SCRT were older with worse comorbidities , and were less likely to undergo chemotherapy or resection Purpose To determine the safety and efficacy of hypofractionated intensity modulated radiation therapy ( Hypo-IMRT ) using helical tomotherapy ( HT ) with concurrent low dose temozolomide ( TMZ ) followed by adjuvant TMZ in patients with glioblastoma multiforme ( GBM ) . Methods and material sAdult patients with GBM and KPS > 70 were prospect ively enrolled between 2005 and 2007 in this phase I study . The Fibonacci dose escalation protocol was implemented to establish a safe radiation fractionation regimen . The protocol defined radiation therapy ( RT ) dose level I as 54.4 Gy in 20 fractions over 4 weeks and dose level II as 60 Gy in 22 fractions over 4.5 weeks . Concurrent TMZ followed by adjuvant TMZ was given according to the Stupp regimen . The primary endpoints were feasibility and safety of Hypo-IMRT with  concurrent TMZ .  Secondary endpoints included progression free survival ( PFS ) , pattern of failure , overall survival ( OS ) and incidence of pseudoprogression . The latter was defined as clinical or radiological suggestion of tumour progression within three months of radiation completion followed by spontaneous recovery of the patient . Results A total of 25 patients were prospect ively enrolled with a median follow-up of 12.4 months . The median age at diagnosis was 53 years . Based on recursive partitioning analysis ( RPA ) criteria , 16 % , 52 % and 32 % of the patients were RPA class III , class IV and class V , respectively . All patients completed concurrent RT and TMZ , and 19 patients ( 76.0 % ) received adjuvant TMZ . The median OS was 15.67 months ( 95 % CI 11.56 - 20.04 ) and the median PFS was 6.7 months ( 95 % CI 4.0 – 14.0 ) . The median time between surgery and start of RT was 44 days ( range of 28 to 77 days ) . Delaying radiation therapy by more than 6 weeks after surgery was an independent prognostic factor associated with a worse OS ( 4.0 vs. 16.1 months , P = 0.027 ) . All recurrences occurred within 2 cm of the original gross tumour volume ( GTV ) . No cases of pseudoprogression were identified in our cohort of patients . Three patients tolerated dose level I with no dose limiting toxicity and hence the remainder of the patients were treated with dose level II according to the dose escalation protocol . Grade 3–4 hematological toxicity was limited to two patients and one patient developed Grade 4 Pneumocystis jiroveci pneumonia . Conclusion Hypo-IMRT using HT given with concurrent TMZ is feasible and safe . The median OS and PFS are comparable to those observed with conventional fractionation . Hypofractionated radiation therapy offers the advantage of a shorter treatment period which is imperative in this group of patients with limited life expectancy PURPOSE Older patients with newly diagnosed glioblastoma have poor outcomes , and optimal treatment is controversial . Hypofractionated radiation therapy ( HRT ) is frequently used but has not been compared to patients receiving st and ard fractionated radiation therapy ( SRT ) and temozolomide ( TMZ ) . METHODS AND MATERIAL S We conducted a retrospective analysis of patients ≥65 years of age who received radiation for the treatment of newly diagnosed glioblastoma from 1994 to 2013 . The distribution of clinical covariates across various radiation regimens was analyzed for possible selection bias . Survival was calculated using the Kaplan-Meier method . Comparison of hypofractionated radiation ( typically , 40 Gy/15 fractions ) versus st and ard fractionation ( typically , 60 Gy/30 fractions ) in the setting of temozolomide was conducted using Cox regression and propensity score analysis . RESULTS Patients received SRT + TMZ ( n=57 ) , SRT ( n=35 ) , HRT + TMZ ( n=34 ) , or HRT ( n=9 ) . Patients receiving HRT were significantly older ( median : 79 vs 69 years of age ; P<.001 ) and had worse baseline performance status ( P<.001 ) than those receiving SRT . On multivariate analysis , older age ( adjusted hazard ratio [ AHR ] : 1.06 ; 95 % confidence interval [ CI ] : 1.01 - 1.10 , P=.01 ) , lower Karnofsky performance status ( AHR : 1.02 ; 95 % CI : 1.01 - 1.03 ; P=.01 ) , multifocal disease ( AHR : 2.11 ; 95 % CI : 1.23 - 3.61 , P=.007 ) , and radiation alone ( vs SRT + TMZ ; SRT : AHR : 1.72 ; 95 % CI : 1.06 - 2.79 ; P=.03 ; HRT : AHR : 3.92 ; 95 % CI : 1.44 - 10.60 , P=.007 ) were associated with decreased overall survival . After propensity score adjustment , patients receiving HRT with TMZ had similar overall survival compared with those receiving SRT with TMZ ( AHR : 1.10 , 95 % CI : 0.50 - 2.4 , P=.82 ) . CONCLUSIONS With no r and omized data demonstrating equivalence between HRT and SRT in the setting of TMZ for glioblastoma , significant selection bias exists in the implementation of HRT . Controlling for this bias , we observed similar overall survival for HRT and SRT with concurrent TMZ among elderly patients , suggesting the need for a r and omized trial to compare these regimens directly PURPOSE To compare conventional fractionation with hypofractionation in patients with a glioblastoma multiforme . Endpoints of the analysis are overall survival and palliative effect . MATERIAL S AND METHODS From 1988 to 1998 , 155 patients with pathologically confirmed glioblastoma multiforme were prospect ively analysed . Patients without irradiation and patients receiving an interstitial boost  were excluded from this analysis . Three different radiation schemes were used in subsequent periods ; 33x2 , 8x5 and 4x7 Gy . In the last 5 years a scheme of 4x7 Gy conformal irradiation was given to poor prognosis patients . The more favourable group received the conventionally fractionated scheme up to 66 Gy . RESULTS Median survival was 7 , 5.6 and 6.6 months for the 33x2 , 8x5 and 4x7 Gy , respectively . In general , patients in the hypofractionation group had far worse prognostic factors compared with patients treated with the conventional scheme . The period of neurological improvement or stabilisation was similar between the 4x7 and 33x2 Gy group . CONCLUSION An extreme hypofractionation scheme of 4x7 Gy conformal irradiation in poor prognostic glioblastoma patients is well tolerated , convenient for the patient and provides equal palliation without negative effects on survival compared with conventional fractionation Objectives The optimal treatment for elderly patients ( age > 70 years ) with glioblastoma ( GBM ) remains controversial . We conducted a prospect i ve trial in 43 consecutive elderly patients with GBM treated with hypofractionated radiotherapy ( RT ) followed by adjuvant temozolomide . Patients and methods Forty-three patients 70 years of age or older with a newly diagnosed GBM and a Karnofsky performance status ( KPS ) ≥ 60 were treated with hypofractionated RT ( 6 fractions of 5 Gy each for a total of 30 Gy over 2 weeks ) followed by up to 12 cycles of adjuvant temozolomide ( 150–200 mg/m2 for 5 days during each 28 day cycle ) . The HRQOL was assessed with the EORTC Quality of Life Question naire C30 . The primary endpoint was overall survival ( OS ) . Secondary endpoints included progression free survival ( PFS ) , toxicity and quality of life . Results The median OS was 9.3 months and the median PFS was 6.3 months . The 6 and 12 month survival rates were 86 % and 35 % , respectively . The 6 and 12 month PFS rates were 55 % and 12 % , respectively . In multivariate analysis KPS was the only significant independent predictive factor of survival ( P = 0.008 ) . Neurological deterioration occurred during or after RT in 16 % of patients and was resolved in most cases with the use of steroids . Grade 3–4 hematologic toxicity occurred in 28 % of patients during the adjuvant chemotherapy treatment with temozolomide . The treatment had no negative effect on HRQOL , however , fatigue ( P = 0.02 ) and constipation ( P = 0.01 ) scales worsened over time . Conclusions Hypofractionated RT followed by temozolomide may provide survival benefit maintaining a good quality of life in elderly patients with GBM . It may represent a reasonable therapeutic approach especially in patients with less favourably prognostic factors Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more To compare progression-free ( PFS ) and overall survival ( OS ) in patients treated in two consecutive phase II trials of hypofractionated-intensity modulated radiotherapy ( hypo-IMRT ) and temozolomide ( TMZ ) with or without bevacizumab ( BEV ) .  Patients with newly diagnosed glioblastoma multiforme ( GBM ) after biopsy or resection were enrolled on a clinical trial with hypo-IMRT and TMZ ( hypo-IMRT/TMZ alone ) from 2008 to 2010 , or in the second protocol with the same hypo-IMRT and TMZ plus BEV ( hypo-IMRT/TMZ/BEV ) from 2010 to 2013 . All patients received postoperative hypo-IMRT to the surgical cavity and residual tumor plus margin to a total dose of 60 Gy and to the T2 abnormality with margin to 30 Gy , both in ten fractions . Concurrent TMZ ( 75 mg/m2/day ) was given to all patients for 28 consecutive days followed by adjuvant TMZ ( 150–200 mg/m2/day ) . Patients enrolled on the hypo-IMRT/TMZ/BEV trial received concurrent and adjuvant BEV ( 10 mg/kg ) on days 1 and 15 of each 28-day cycle . Hazard ratios of PFS and OS were compared between trials in a Cox proportional hazards model . Twenty-six patients were enrolled on the hypo-IMRT/TMZ alone trial and 30 patients on the hypo-IMRT/TMZ/BEV  trial  . Median follow-up was 13.9 and 14.7 months , respectively . Median PFS was 3 
    Output:
    
Conclusions : HRF is efficacious and safe for the treatment of GBM .
In individuals aged > 70 years , treatment with HRF is superior to CFR in terms of OS .