Should ultra-short course RT be standard for elderly or poor performance status patients with glioblastoma?

The recent phase III randomized trial published by Roa et al. examining the efficacy of short course radiotherapy in elderly and/or frail patients with newly diagnosed GBM builds upon his previous work finding equivalent outcomes in elderly patients (age > 60 years) receiving 60 Gy in 30 fractions ...

I do not use "elderly" as a decision-making criterion, because the functional status is frequently relatively age-independent. In general, for patients with poor performance status, the short-fraction schedule is "OK". Do remember that this is quite hypofractionated and so be prepared to deal with p...

This study makes a strong argument for using short fractionation for patients with a poor performance status who are not candidates for chemotherapy and have short expected survival.

The Nordic randomised trial also showed 34 in 10 fractions was better than 60 Gy in 30 fractions in the elderly.

The ne...

I find this useful for biopsy only IDH WT elderly patients; I have a hard time, though, knowing what size limitations there are? Does anybody have a 5cm cut off or anything like that? Also, how do you decide on treatment vs hospice and steroids?