Department of Radiotherapy and OncologyJohann Wolfgang Goethe University, Frankfurt/Main, Germany.
Radiother Oncol. 2010 Dec;97(3):382-6. doi: 10.1016/j.radonc.2010.06.014. Epub 2010 Sep 17.
The addition of temozolomide (TMZ) to radiotherapy (RT) improves survival of patients with glioblastoma (GB) when compared to postoperative RT alone in patients up to 65 years of age. In older patients, RT alone has remained the standard of care because there is concern that radiochemotherapy causes excess toxicity and is less efficacious in this population, but no randomized trials have been reported. We retrospectively assessed feasibility, toxicity and outcome in elderly patients treated at a single institution with RT and concomitant TMZ.
Between 04/1999 and 9/2009, 51 patients ≥65 years (median age 70 years, range 65-84) with GB were treated by RT (total dose 60 Gy in 30 fractions) and concomitant TMZ (75 mg/m(2)/day throughout RT). Biopsy only had been performed in 23 patients (45.1%), 15 patients (29.4%) had undergone partial resection, and 13 patients (25.5%) macroscopically complete resection. Adjuvant TMZ was applied in 10 of 51 patients.
Median overall survival (OS) and progression-free survival (PFS) were 11.5 (95% CI, 6.7-16.3) and 5.5 months (95% CI, 3.7-7.3 months), respectively, in the total cohort. After complete resection, partial resection and biopsy, median OS was 27.4, 15.5 and 7.9 months (p=0.002), respectively. In multivariate Cox proportional hazards regression models extent of resection (p<0.0001) and Karnofsky's performance score (p=0.002) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 30 patients (59%). Five patients (10%) discontinued RT because of disease progression (n=4) or toxicity (pneumonia, n=1). Another 16 patients interrupted concomitant chemotherapy (cytopenia: 9; pneumonia: 2; transaminase elevation: 2; rash: 3).
RT with concomitant TMZ is a feasible regimen with acceptable toxicity in elderly patients. The promising outcome in patients with good performance status and patients with gross total resections are notable.
与术后单独接受放疗（RT）相比，替莫唑胺（TMZ）联合放疗可改善 65 岁以下患者的胶质母细胞瘤（GB）生存。对于年龄较大的患者，单独接受 RT 一直是标准治疗方法，因为人们担心放化疗会引起过度毒性，并且在该人群中效果较差，但尚无随机试验报告。我们回顾性评估了在一家机构中，使用 RT 联合 TMZ 治疗的老年患者的可行性、毒性和结局。
1999 年 4 月至 2009 年 9 月，51 例年龄≥65 岁（中位年龄 70 岁，范围 65-84 岁）的 GB 患者接受 RT（总剂量 60 Gy，30 次分割）和 TMZ 同期治疗（TMZ 剂量为 75 mg/m2/天，持续 RT 期间）。23 例患者（45.1%）仅行活检，15 例患者（29.4%）行部分切除术，13 例患者（25.5%）行大体全切除术。51 例患者中有 10 例接受辅助 TMZ 治疗。
在总队列中，中位总生存期（OS）和无进展生存期（PFS）分别为 11.5（95%CI，6.7-16.3）和 5.5 个月（95%CI，3.7-7.3 个月）。完全切除、部分切除和活检后，中位 OS 分别为 27.4、15.5 和 7.9 个月（p=0.002）。在多变量 Cox 比例风险回归模型中，切除范围（p<0.0001）和 Karnofsky 表现评分（p=0.002）是 OS 的显著独立预后因素。大多数患者可耐受 RT 联合 TMZ 治疗，30 例（59%）可按计划完成放疗。5 例患者（10%）因疾病进展（n=4）或毒性（肺炎，n=1）而停止 RT。另有 16 例患者中断了同期化疗（血细胞减少症：9 例；肺炎：2 例；转氨酶升高：2 例；皮疹：3 例）。
在老年患者中，RT 联合 TMZ 是一种可行的方案，其毒性可接受。对于表现状态良好和大体全切除的患者，其预后较好。
