Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, ON, Canada.
Cancer Treat Rev. 2013 Jun;39(4):350-7. doi: 10.1016/j.ctrv.2012.05.008. Epub 2012 Jun 19.
Median age at diagnosis in patients with glioblastoma (GB) is slowly increasing with an aging population in Western countries, and was 64years in 2006. The number of patients age 65 and older with GB will double in 2030 compared with 2000. Survival in this older cohort of patients is significantly less than seen in younger patients. This may in part be related to more aggressive biology of tumor, reduced use of standard management approaches, increased toxicity of available therapies, and increased presence of comorbidities in this older patient population. Limited data do support the use of more extensive resection in these patients. Randomized data support the use of post-operative radiotherapy (RT) versus supportive care, but do not demonstrate a benefit for the use of the standard 6weeks course of RT over hypofractionated RT given over 3weeks. Preliminary data of randomized studies raise the possibility of temozolomide alone as an option for these patients. The use of 6weeks of RT with concurrent and adjuvant temozolomide has been associated with reasonably good survival in several uncontrolled small series of selected older patients; however, this better outcome may be related to the selection of better prognosis patients rather than the specific therapy utilized. The current National Cancer Institute of Canada (NCIC) and European Organization for Research and Treatment of Cancer (EORTC) CE.6/26062/22061 randomized study of short course RT with or without concurrent and adjuvant temozolomide will help determine the optimal therapy for this older cohort with currently available therapies.
在西方国家，随着人口老龄化，胶质母细胞瘤（GB）患者的诊断中位年龄逐渐增加，2006 年为 64 岁。到 2030 年，65 岁及以上的 GB 患者人数将是 2000 年的两倍。与年轻患者相比，这一年龄较大患者群体的生存率明显较低。这可能部分与肿瘤更具侵袭性的生物学特性、标准治疗方法的使用减少、现有治疗方法毒性增加以及该老年患者群体中合并症的增加有关。有限的数据确实支持在这些患者中采用更广泛的切除。随机数据支持术后放疗（RT）与支持性护理相比，但并未证明标准 6 周 RT 疗程优于 3 周内进行的低分割 RT。随机研究的初步数据提出了替莫唑胺单独作为这些患者的一种选择的可能性。在几项未经对照的老年患者选择小系列中，6 周 RT 联合同期和辅助替莫唑胺治疗与相当好的生存相关；然而，这种更好的结果可能与选择预后较好的患者有关，而不是与所使用的特定治疗有关。目前，加拿大国家癌症研究所（NCIC）和欧洲癌症研究与治疗组织（EORTC）CE.6/26062/22061 的短期 RT 联合或不联合同期和辅助替莫唑胺的随机研究将有助于确定目前可用治疗方法对这一年龄较大患者群体的最佳治疗方法。
