Brandes Alba A, Monfardini Silvio
Medical Oncology Department, Azienda Ospedale-Università, Padova, Italy.
Semin Oncol. 2003 Dec;30(6 Suppl 19):58-62. doi: 10.1053/j.seminoncol.2003.11.025.
Elderly patients with cancer are frequently excluded from cancer therapy trials, treated suboptimally, or not treated at all because of the widely held belief that elderly patients do not tolerate chemotherapy and/or radiotherapy (RT) as well as younger patients. Excluding elderly patients from conventional treatment, chemotherapy in particular, is often based on ad hoc decisions rather than on sound scientific data. Malignant gliomas are the most common primary brain tumors in adults, and the age-adjusted incidence of high-grade gliomas has increased over recent years, especially in the elderly. However, few investigators focus on the treatment of high-grade gliomas in the elderly. Data from retrospective studies and meta-analyses suggest that elderly patients with high-grade gliomas have a poorer outcome than younger patients, possibly because of the presence of comorbidity, resistance to cancer therapy, genetic aberrations, different histology, neurodegeneration, or age discrimination. The optimal treatment of elderly patients with high-grade gliomas has not been determined. Surgical debulking and postoperative RT are associated with a significant increase in survival among elderly patients who are in good clinical condition. A recent report has shown that treatment with temozolomide (Temodar [US], Temodal [international]; Schering-Plough Corporation, Kenilworth, NJ) plus RT provides a significant survival benefit compared with RT alone and a significantly improved time to progression compared with RT plus standard chemotherapy (lomustine, procarbazine, and vincristine). Further, temozolomide was well tolerated in the elderly patient population and was less toxic than standard chemotherapy. Therefore, it could be recommended that a full course of RT be followed by adjuvant temozolomide in elderly patients with good prognostic factors. Further, temozolomide alone could be considered as a treatment option for elderly patients with glioblastoma with poorer performance status and for patients who cannot tolerate RT. Results from larger prospective trials will determine the optimal role of chemotherapy, particularly temozolomide, in elderly patients with malignant gliomas.
患有癌症的老年患者常常被排除在癌症治疗试验之外，接受的治疗不够理想，或者根本得不到治疗，因为人们普遍认为老年患者对化疗和/或放疗的耐受性不如年轻患者。将老年患者排除在常规治疗之外，尤其是化疗，往往是基于临时决定，而非可靠的科学数据。恶性胶质瘤是成人中最常见的原发性脑肿瘤，近年来高级别胶质瘤的年龄调整发病率有所上升，尤其是在老年人中。然而，很少有研究人员关注老年患者高级别胶质瘤的治疗。回顾性研究和荟萃分析的数据表明，患有高级别胶质瘤的老年患者的预后比年轻患者差，这可能是由于存在合并症、对癌症治疗的耐药性、基因畸变、不同的组织学类型、神经退行性变或年龄歧视。老年患者高级别胶质瘤的最佳治疗方案尚未确定。对于临床状况良好的老年患者，手术减瘤和术后放疗可显著提高生存率。最近的一份报告显示，与单纯放疗相比，替莫唑胺（美国的Temodar，国际的Temodal；先灵葆雅公司，新泽西州肯尼沃思）联合放疗可显著提高生存率，与放疗加标准化疗（洛莫司汀、丙卡巴肼和长春新碱）相比，疾病进展时间也显著延长。此外，替莫唑胺在老年患者群体中耐受性良好，毒性比标准化疗小。因此，对于具有良好预后因素的老年患者，建议在全疗程放疗后使用辅助性替莫唑胺。此外，对于功能状态较差的老年胶质母细胞瘤患者以及无法耐受放疗的患者，可考虑单独使用替莫唑胺作为治疗选择。更大规模前瞻性试验的结果将确定化疗，尤其是替莫唑胺，在老年恶性胶质瘤患者中的最佳作用。
