Top Line: Hypofractionated radiation over 15 fractions is generally preferred for patients over 70 with glioblastoma multiforme (GBM) based on robust randomized data in this population.
The Study: The phase 3 GOLD trial took things a step further by randomizing 135 enrollees of all ages to standard chemoradiation over 30 fractions versus ultra-hypofractionated treatment over only 6 fractions. The experimental arm received 4 Gy x 6 = 24 Gy to gross tumor plus 1.5 cm margin and a simultaneous boost of 6 Gy x 6 = 36 Gy to gross tumor plus 0.5 cm margin delivered three fractions per week during 2 weeks. Accrual of enrollees was slow, closing after only 135 of a planned 474. Even still, median overall survival was significantly longer in the standard (21 months) versus ultra-hypofractionated (13 months) arm. Survival curves separately sharply after 6 months, potentially due to emerging divergent rates of radiation necrosis (16% versus 48%, HR 5.20). The authors reiterate these results should not deter from established hypofractionated regimens such as 40 Gy 15 fractions standardly used in elderly and/or frail patients.
TBL: In this randomized trial, ultra-hypofractionation was clearly inferior to standard conventionally-fractionationated chemoradiation for fit patients with GBM. | de Jong, Radiother Oncol 2026
The Study: The phase 3 GOLD trial took things a step further by randomizing 135 enrollees of all ages to standard chemoradiation over 30 fractions versus ultra-hypofractionated treatment over only 6 fractions. The experimental arm received 4 Gy x 6 = 24 Gy to gross tumor plus 1.5 cm margin and a simultaneous boost of 6 Gy x 6 = 36 Gy to gross tumor plus 0.5 cm margin delivered three fractions per week during 2 weeks. Accrual of enrollees was slow, closing after only 135 of a planned 474. Even still, median overall survival was significantly longer in the standard (21 months) versus ultra-hypofractionated (13 months) arm. Survival curves separately sharply after 6 months, potentially due to emerging divergent rates of radiation necrosis (16% versus 48%, HR 5.20). The authors reiterate these results should not deter from established hypofractionated regimens such as 40 Gy 15 fractions standardly used in elderly and/or frail patients.
TBL: In this randomized trial, ultra-hypofractionation was clearly inferior to standard conventionally-fractionationated chemoradiation for fit patients with GBM. | de Jong, Radiother Oncol 2026