Service de Neurologie Mazarin, Hôpital de la Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France.
J Neurooncol. 2010 Aug;99(1):89-94. doi: 10.1007/s11060-009-0110-3. Epub 2010 Jan 8.
Upfront temozolomide (TMZ) is often proposed for elderly patients with malignant gliomas as an alternative to radiotherapy (RT). A recent randomized trial showed that RT provides a survival benefit in elderly glioblastoma patients (>or=70 years) with good performance status (KPS >or= 70) compared with supportive care alone (median survival (MS) = 29.1 vs. 16.9 weeks). We retrospectively analyzed all patients who were eligible for this trial, but who refused to participate and were finally treated with TMZ alone. Thirty-nine eligible patients (median age: 75 years (range 70-83), median KPS: 70 (range 70-80), histologically proven glioblastomas) were treated up-front with oral TMZ for 1-12 cycles (mean = 5). One complete response and 10 partial responses were observed. Overall median survival (MS) was 36 weeks and median progression-free survival (PFS) was 20 weeks for the whole group. MS was 27.4 weeks and PFS was 19.5 weeks for the 27 patients that did not receive second-line treatment at progression. Eight grade III/IV toxicities (seven hematologic, one gastro-intestinal) were seen, but no treatment-related deaths were observed. These preliminary results support further randomized studies comparing TMZ with RT.
替莫唑胺（TMZ）作为一种替代放疗（RT）的方法，常被推荐用于老年恶性脑胶质瘤患者。最近一项随机试验显示，与单纯支持治疗相比，对于表现状态良好（KPS≥70）的老年胶质母细胞瘤患者（≥70 岁），放疗可提供生存获益（中位生存期（MS）=29.1 与 16.9 周）。我们回顾性分析了所有符合该试验条件但拒绝参加试验并最终单独接受 TMZ 治疗的患者。39 名符合条件的患者（中位年龄：75 岁（70-83 岁），中位 KPS：70（70-80），组织学证实为胶质母细胞瘤）接受 TMZ 单药治疗，共 1-12 个周期（平均=5 个）。观察到 1 例完全缓解和 10 例部分缓解。全组中位总生存期（MS）为 36 周，中位无进展生存期（PFS）为 20 周。在进展时未接受二线治疗的 27 例患者中，MS 为 27.4 周，PFS 为 19.5 周。8 例发生 3/4 级毒性（7 例血液学毒性，1 例胃肠道毒性），但无治疗相关死亡。这些初步结果支持进一步比较 TMZ 与 RT 的随机研究。
