Chinot Olivier L
Unité de Neuro-Oncologie, Service de Neurochirurgie, CHU Timone, 264, rue Saint Pierre, 13385 Marseille Cedex 05 France.
Semin Oncol. 2003 Dec;30(6 Suppl 19):68-71. doi: 10.1053/j.seminoncol.2003.11.027.
Elderly patients with malignant gliomas present unique treatment challenges. Data are limited on the efficacy of various treatment modalities for high-grade gliomas in the elderly patient population, particularly for patients over 70 years of age, and the most appropriate treatment strategies remain a matter of debate. These patients generally have a poor clinical course and lower tolerance to therapy compared with younger patients. Standard radiotherapy (RT) may provide a survival benefit for patients with a good Karnofsky performance status (>/=70); however, RT is associated with significant neurologic toxicity in elderly patients. Some argue that the apparent modest clinical benefits of RT do not outweigh the risks and inconvenience of the standard schedule. Clearly, more effective and better-tolerated treatments are needed. Chemotherapy agents with good safety profiles, such as oral temozolomide (Temodar [US], Temodal [international]; Schering-Plough Corporation, Kenilworth, NJ), are being considered as alternatives to RT. When used as single-agent therapy, temozolomide induced objective responses and improved neurologic status in elderly patients with newly diagnosed, unresected glioblastoma. For patients with good performance status, treatment options should be discussed and the risks and potential benefits of RT carefully considered. Furthermore, prospective randomized studies should be performed to define the best therapeutic option for efficacy, toxicity, convenience, and quality of life.
老年恶性胶质瘤患者面临独特的治疗挑战。关于各种治疗方式对老年患者群体中高级别胶质瘤的疗效数据有限，尤其是70岁以上的患者，最合适的治疗策略仍存在争议。与年轻患者相比，这些患者的临床病程通常较差，对治疗的耐受性也较低。标准放疗（RT）可能会使卡诺夫斯基表现状态良好（≥70）的患者获得生存益处；然而，放疗在老年患者中会带来显著的神经毒性。一些人认为，放疗明显适度的临床益处并不超过标准疗程的风险和不便。显然，需要更有效且耐受性更好的治疗方法。具有良好安全性的化疗药物，如口服替莫唑胺（美国的泰道，国际的蒂清；先灵葆雅公司，新泽西州肯尼沃思），正被视为放疗的替代方案。当作为单药治疗使用时，替莫唑胺可使新诊断、未切除的胶质母细胞瘤老年患者产生客观反应并改善神经状态。对于表现状态良好的患者，应讨论治疗选择，并仔细考虑放疗的风险和潜在益处。此外，应进行前瞻性随机研究，以确定在疗效、毒性、便利性和生活质量方面的最佳治疗方案。
