The median age of the NOA-08 trial, a trial comparing chemotherapy to RT in elderly patients, was 71 vs. 72 years, the median OS was 8.6 for TMZ and 9.4 months for RT, p = 0.033. The trial also analysed the impact of MGMT promotor methylation and described the predictive value for MGMT for the efficacy of TMZ. Similar results were reported from the Nordic Trial, which furthermore reported a small but significant positive effect of either TMZ or hypofractionated RT to a standard fractionated RT . The trial included patients with an age of 60 years or older, the difference described above was more pronounced within the group of patients older than 70 years. Rao et al. randomized patients with a minimum age of 60 years and a mean age of 72.4 and 71 years to receive either a 6 week normofractionated or a 3 week hypofractionated regimen. Both groups had a median KPS of 70%. The trial was closed earlier due to high similarity between the two arms. The trial demonstrated equal efficacy of both dosing schemes, with a median OS of 5.1 and 5.6 months. Notably, Gross Total Resection (GTR) was achieved in only 4.2 and 14.6% of the cases, almost 40% received biopsy only . A mono-institutional report from Ontario, Canada, reported about hypofractionated RT with and without concurrent TMZ. GTR was achieved in one third of the patients. The median survival was superior for the mono-RT group (6.9 vs. 9.3 months), yet the difference was not significant. Similar to our results, also elderly patients had a significant benefit from salvage therapies (5.7 vs. 13.3 months) . Already in 2008, Combs et al. demonstrated the efficacy and safety of RChT for patients older than 65 years. This cohort had a median survival of 11 months, a subgroup with gross total resection had a median survival of 18 months . Only recently, results from the randomized phase III EORTC 26062–22061 / TROG 08.02-Trial were presented by Perry and colleagues. 562 patients were randomized between a hypofractionated RT up to 40.05 Gy alone or in combination with concurrent TMZ. In opposite to the retrospective data from Cao et al., this trial showed a significant advantage for the combined modality treatment (7.6 vs 9.3 months). Importantly, also patients with non-methylated MGMT-promotor benefited from concurrent radiochemotherapy . Unfortunately, the article did not report whether also patients with ECOG 2 did profit from the combined modality treatment. In our cohort, albeit not significant, patients with an ECOG 1 did profit more than patients with ECOG 2. In our view, the radiotherapy treatment regimen could be an important reason for this difference. Hypofractionated radiotherapy was shown to be equally effective in elderly and frail patients not eligible to standard fractionated treatment [10, 11, 17], but concerns about the long term safety have been raised . On the other hand, nether safety nor efficiency of hypofractionated and standard-fractionated RChT have been compared directly. Taken that in hypofractionated treatments the concomitant chemotherapy time it cut in half, medically fit patients (ECOG 0 and 1) treated according to the Perry-Study can be considered to be under risk of being undertreated. A standard fractionated RChT therefore should be deemed to be the standard of care for elderly patients with a good performance status. This concepts has been published previously, stressing the necessity of proactive treatment in medically fit patients above age 65 years .