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老年胶质母细胞瘤患者采用大分割放疗后联合替莫唑胺辅助化疗。

Hypofractionated radiotherapy followed by adjuvant chemotherapy with temozolomide in elderly patients with glioblastoma.

作者信息

Minniti Giuseppe, De Sanctis V, Muni R, Rasio D, Lanzetta G, Bozzao A, Osti M F, Salvati M, Valeriani M, Cantore G P, Maurizi Enrici R

机构信息

Department of Radiotherapy Oncology, Sant' Andrea Hospital, University "La Sapienza", Via di Grottarossa 1035, 00189, Rome, Italy.

出版信息

J Neurooncol. 2009 Jan;91(1):95-100. doi: 10.1007/s11060-008-9689-z. Epub 2008 Aug 29.

Abstract

OBJECTIVES

The optimal treatment for elderly patients (age >70 years) with glioblastoma (GBM) remains controversial. We conducted a prospective trial in 43 consecutive elderly patients with GBM treated with hypofractionated radiotherapy (RT) followed by adjuvant temozolomide.

PATIENTS AND METHODS

Forty-three patients 70 years of age or older with a newly diagnosed GBM and a Karnofsky performance status (KPS) > or = 60 were treated with hypofractionated RT (6 fractions of 5 Gy each for a total of 30 Gy over 2 weeks) followed by up to 12 cycles of adjuvant temozolomide (150-200 mg/m(2) for 5 days during each 28 day cycle). The HRQOL was assessed with the EORTC Quality of Life Questionnaire C30. The primary endpoint was overall survival (OS). Secondary endpoints included progression free survival (PFS), toxicity and quality of life.

RESULTS

The median OS was 9.3 months and the median PFS was 6.3 months. The 6 and 12 month survival rates were 86% and 35%, respectively. The 6 and 12 month PFS rates were 55% and 12%, respectively. In multivariate analysis KPS was the only significant independent predictive factor of survival (P = 0.008). Neurological deterioration occurred during or after RT in 16% of patients and was resolved in most cases with the use of steroids. Grade 3-4 hematologic toxicity occurred in 28% of patients during the adjuvant chemotherapy treatment with temozolomide. The treatment had no negative effect on HRQOL, however, fatigue (P = 0.02) and constipation (P = 0.01) scales worsened over time.

CONCLUSIONS

Hypofractionated RT followed by temozolomide may provide survival benefit maintaining a good quality of life in elderly patients with GBM. It may represent a reasonable therapeutic approach especially in patients with less favourably prognostic factors.

摘要

目的

胶质母细胞瘤(GBM)老年患者(年龄>70岁)的最佳治疗方案仍存在争议。我们对43例连续的老年GBM患者进行了一项前瞻性试验,这些患者接受了超分割放疗(RT),随后给予辅助替莫唑胺治疗。

患者与方法

43例70岁及以上新诊断为GBM且卡诺夫斯基功能状态(KPS)≥60的患者接受了超分割RT(每次5 Gy,共6次,2周内总计30 Gy),随后进行多达12个周期的辅助替莫唑胺治疗(每个28天周期的5天内给予150 - 200 mg/m²)。使用欧洲癌症研究与治疗组织生活质量问卷C30评估健康相关生活质量(HRQOL)。主要终点是总生存期(OS)。次要终点包括无进展生存期(PFS)、毒性和生活质量。

结果

中位OS为9.3个月,中位PFS为6.3个月。6个月和12个月生存率分别为86%和35%。6个月和12个月PFS率分别为55%和12%。多因素分析中,KPS是生存的唯一显著独立预测因素(P = 0.008)。16%的患者在RT期间或之后出现神经功能恶化,大多数情况下使用类固醇后症状得到缓解。28%的患者在辅助化疗使用替莫唑胺治疗期间出现3 - 4级血液学毒性。该治疗对HRQOL没有负面影响,然而,疲劳(P = 0.02)和便秘(P = 0.01)量表评分随时间恶化。

结论

超分割RT后给予替莫唑胺可能为老年GBM患者提供生存益处并维持良好的生活质量。它可能是一种合理的治疗方法,尤其是对于预后因素不太有利的患者。

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