Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
J Neurooncol. 2012 Sep;109(2):391-7. doi: 10.1007/s11060-012-0906-4. Epub 2012 Jun 12.
Survival of elderly patients with glioblastoma (GBM) is poor, but improves with tumor resection and radiotherapy (RT). Concurrent temozolomide (TMZ) chemotherapy during RT improves the survival of younger patients with GBM, but the benefit in elderly patients is unclear. Medical records of patients ≥65 years old with primary GBM, histologically confirmed at Memorial Sloan-Kettering Cancer Center and treated with RT, were reviewed. Survival was associated with patient (age, performance status), tumor (single or multiple), and treatment (extent of surgery, RT field, technique, fractionation and use of concurrent TMZ) characteristics in a multivariable Cox regression model. Grade ≥3 hematologic toxicity rates were compared to reported rates in younger patients. Median age of the 291 patients studied was 71 years. Longer survival was associated with younger age, tumor resection, and concomitant TMZ and RT (p < 0.01). Concurrent TMZ and RT improved median survival of patients with favorable prognostic factors from 12 to 21 months and from 10 to 13 months in patients 65-70 and ≥71 years old, respectively. Concomitant TMZ and RT increased the 2 year OS rate from 14 to 41 % and from 5 to 24 % in patients 65-70 and ≥71 years old, respectively. Grade 3-4 thrombocytopenia was significantly more frequent in the present cohort. Survival of elderly patients with GBM may be prolonged with the use of concomitant TMZ during RT. An ongoing randomized study will determine the benefit of this approach in a prospective fashion.
老年胶质母细胞瘤（GBM）患者的生存率较差，但肿瘤切除和放疗（RT）可改善预后。在 RT 期间同时给予替莫唑胺（TMZ）化疗可改善年轻 GBM 患者的生存率，但对老年患者的益处尚不清楚。我们回顾了在纪念斯隆-凯特琳癌症中心经组织学证实的原发性 GBM 且接受 RT 治疗的年龄≥65 岁的患者的病历。采用多变量 Cox 回归模型，将生存与患者（年龄、一般状况）、肿瘤（单发或多发）和治疗（手术范围、RT 野、技术、分割和是否同时使用 TMZ）特征相关联。并将≥3 级血液学毒性发生率与年轻患者的报告发生率进行了比较。研究的 291 例患者的中位年龄为 71 岁。较年轻的年龄、肿瘤切除、同时使用 TMZ 和 RT 与生存时间延长相关（p<0.01）。同时使用 TMZ 和 RT 使预后良好的患者的中位生存时间从 12 个月延长至 21 个月，使 65-70 岁和≥71 岁的患者的中位生存时间从 10 个月延长至 13 个月。同时使用 TMZ 和 RT 使 65-70 岁和≥71 岁的患者 2 年 OS 率从 14%分别提高到 41%和从 5%提高到 24%。本队列中 3-4 级血小板减少症的发生率显著更高。在 RT 期间同时使用 TMZ 可能会延长老年 GBM 患者的生存时间。一项正在进行的随机研究将前瞻性地确定这种方法的获益。
