Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do 519-809, South Korea.
J Clin Neurosci. 2013 Apr;20(4):503-8. doi: 10.1016/j.jocn.2012.03.044. Epub 2013 Jan 11.
For elderly patients with glioblastoma multiforme (GBM), radiotherapy plus concomitant and adjuvant temozolomide has resulted in longer survival. We investigated patient performance status, treatment-related toxicity and overall survival (OS) following treatment. Twenty patients aged 70years or older with a newly diagnosed GBM were treated with radiotherapy (60Gy in 16 patients and 40Gy in four patients) plus concomitant and adjuvant temozolomide. We assessed age, the extent of tumor removal, and initial performance status as possible prognostic factors for OS and good performance status following treatment. The median OS was 11.8months (95% confidence interval [CI], 8.7-14.8). The median time for patients to reach an Eastern Cooperative Oncology Group (ECOG) performance status grade 2 was 3.0months (95% CI, 2.4-3.5), and the time to ECOG performance status grade 3 was 5.8months (95% CI, 1.6-9.9). World Health Organization grade III or grade IV toxicity was observed in four patients (20%), leucopenia and thrombocytopenia was noted in two patients, and major infection occurred in two patients. Univariate analysis showed a significantly longer OS (p=0.003) and a longer time with good performance status for gross total removal (GTR) (p=0.003). An initial good performance status was related to a good performance status during and after treatment (p=0.003). Based on multivariate analysis, GTR was significantly associated with a longer OS (hazard ratio [HR]=0.236; 95% CI, 0.060-0.922, p=0.038) and a good performance status (HR=0.124; 95% CI, 0.022-0.693, p=0.017). During and after treatment, elderly patients with GBM frequently exhibited an early deterioration of performance status. Therefore, in light of a rapidly fatal illness, elderly patients should be treated to preserve and respect their quality of life.
对于患有多形性胶质母细胞瘤 (GBM) 的老年患者，放射治疗联合同时和辅助替莫唑胺治疗可延长生存期。我们研究了患者的表现状态、治疗相关毒性和总生存期 (OS)。20 名年龄在 70 岁或以上的新诊断为 GBM 的患者接受了放射治疗（16 名患者接受 60Gy，4 名患者接受 40Gy）联合同时和辅助替莫唑胺治疗。我们评估了年龄、肿瘤切除程度和初始表现状态作为 OS 和治疗后良好表现状态的可能预后因素。中位 OS 为 11.8 个月（95%置信区间 [CI]，8.7-14.8）。患者达到东部合作肿瘤学组 (ECOG) 表现状态等级 2 的中位时间为 3.0 个月（95%CI，2.4-3.5），达到 ECOG 表现状态等级 3 的时间为 5.8 个月（95%CI，1.6-9.9）。4 名患者（20%）观察到世界卫生组织 (WHO) 3 级或 4 级毒性，2 名患者出现白细胞减少和血小板减少，2 名患者发生严重感染。单因素分析显示，完全切除（GTR）的 OS 显著延长（p=0.003），并且在 GTR 时和治疗后表现状态良好的时间也更长（p=0.003）。初始表现状态良好与治疗中和治疗后表现状态良好相关（p=0.003）。基于多因素分析，GTR 与更长的 OS 显著相关（风险比 [HR]=0.236；95%CI，0.060-0.922，p=0.038），与良好的表现状态显著相关（HR=0.124；95%CI，0.022-0.693，p=0.017）。在治疗中和治疗后，老年 GBM 患者的表现状态经常迅速恶化。因此，鉴于这种迅速致命的疾病，应该治疗老年患者以维持和尊重他们的生活质量。
