Sijben Angelique E, McIntyre John B, Roldán Gloria B, Easaw Jacob C, Yan Elizabeth, Forsyth Peter A, Parney Ian F, Magliocco Anthony M, Bernsen Hans, Cairncross J Gregory
Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
J Neurooncol. 2008 Aug;89(1):97-103. doi: 10.1007/s11060-008-9593-6. Epub 2008 Apr 9.
Elderly patients have glioblastomas (GBM) that are aggressive and poorly responsive to treatment. They are also prone to the side effects of treatment of GBM.
To shed light on the treatment of elderly patients with GBM, we reviewed the treatment toxicities and survival of patients 65 years of age or older who were treated with chemoradiotherapy, which is the new standard of care for GBM in younger patients.
Thirty-nine patients at a single cancer center in Canada met the eligibility criteria for this retrospective study. Nineteen patients were treated initially with TMZ and radiotherapy and 20 others were treated with radiotherapy alone (only two had TMZ subsequently). Eight patients in the chemoradiotherapy group (42%) experienced Grade III or IV toxicity versus none in the radiotherapy group. The median overall survival in the chemoradiotherapy group was 8.5 months (range, 2.0-24.7 months) versus 5.2 months (range, 1.5-14.2 months) in the radiotherapy group, an apparent benefit which may have been due to an imbalance in age at diagnosis, extent of resection and performance status. In this series of GBM cases, methylation of the MGMT gene promoter was not associated with longer survival, either overall, or within the chemoradiotherapy treated subset.
Elderly patients with GBM treated with chemoradiotherapy can be expected to experience significant toxicity. Large randomized trials will be necessary to determine whether chemoradiotherapy prolongs the survival of elderly patients and whether MGMT promoter status predicts benefit from temozolomide in this subset of patients.
老年胶质母细胞瘤（GBM）具有侵袭性，对治疗反应不佳，且易出现GBM治疗的副作用。
为了深入了解老年GBM患者的治疗情况，我们回顾了65岁及以上接受放化疗患者的治疗毒性和生存情况，放化疗是年轻GBM患者新的标准治疗方案。
加拿大一家癌症中心的39例患者符合这项回顾性研究的纳入标准。19例患者最初接受替莫唑胺（TMZ）和放疗，另外20例仅接受放疗（其中只有2例随后接受了TMZ治疗）。放化疗组有8例患者（42%）出现III级或IV级毒性反应，而放疗组无此情况。放化疗组的中位总生存期为8.5个月（范围2.0 - 24.7个月），放疗组为5.2个月（范围1.5 - 14.2个月），这一明显益处可能是由于诊断时年龄、切除范围和体能状态的不平衡所致。在这一系列GBM病例中，O6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）基因启动子的甲基化与总体生存期延长无关，在放化疗治疗的亚组中也是如此。
接受放化疗的老年GBM患者可能会出现显著毒性。需要进行大型随机试验，以确定放化疗是否能延长老年患者的生存期，以及MGMT启动子状态是否能预测该亚组患者从替莫唑胺治疗中获益。
