Putz Florian, Knippen Stefan, Lahmer Godehard, Fietkau Rainer, Semrau Sabine
Department of Radiation Oncology, University of Erlangen-Nuremberg, Erlangen, Germany.
Am J Clin Oncol. 2017 Oct;40(5):523-529. doi: 10.1097/COC.0000000000000198.
It is controversial whether concurrent chemoradiotherapy (CRT) with temozolomide is feasible and beneficial in elderly patients with glioblastoma.
Retrospective analysis of 74 elderly glioblastoma patients (65 y and above) treated with concurrent CRT with temozolomide. Factors influencing prognosis and feasibility of CRT were investigated.
The median overall survival was 11.3 months. Univariate analysis showed a significant difference in median overall survival for cumulative dose of concurrent temozolomide (optimal cutoff, 2655 mg/m; 13.9 mo for >2655 mg/m vs. 4.9 mo for ≤2655 mg/m; P=0.0216, adjusted for multiple testing). Furthermore, cumulative dose of concurrent temozolomide >2655 mg/m was a significant independent prognostic parameter in multivariate analysis (hazard ratio, 0.33; P=0.002). Hematotoxicity was the most common cause of treatment interruption or discontinuation in patients with an insufficient cumulative temozolomide dose. Prognostic factors for successful performance of CRT with a cumulative dose of concurrent temozolomide >2655 mg/m were female sex (odds ratio [OR], 0.174; P=0.006), age (OR, 0.826 per year; P=0.017), and pretreatment platelet count (OR, 1.013 per 1000 platelets/µL; P=0.001). For easy clinical application of the model an online calculator was developed, which is available at http://www.OldTMZ.com.
The probability of successful performance of concurrent CRT with temozolomide can be estimated based on the patient's age, sex, and pretreatment platelet count using the model developed in this study. Thus, a subgroup of elderly glioblastoma patients suitable for chemoradiation with temozolomide can be identified.
替莫唑胺同步放化疗在老年胶质母细胞瘤患者中是否可行且有益存在争议。
对74例接受替莫唑胺同步放化疗的老年胶质母细胞瘤患者（65岁及以上）进行回顾性分析。研究影响同步放化疗预后和可行性的因素。
中位总生存期为11.3个月。单因素分析显示，同步替莫唑胺累积剂量的中位总生存期存在显著差异（最佳截断值为2655mg/m；＞2655mg/m时为13.9个月，≤2655mg/m时为4.9个月；P=0.0216，经多重检验校正）。此外，同步替莫唑胺累积剂量＞2655mg/m在多因素分析中是一个显著的独立预后参数（风险比，0.33；P=0.002）。血液毒性是替莫唑胺累积剂量不足患者治疗中断或停药的最常见原因。同步替莫唑胺累积剂量＞2655mg/m的同步放化疗成功实施的预后因素为女性（优势比[OR]，0.174；P=0.006）、年龄（OR，每年0.826；P=0.017）和治疗前血小板计数（OR，每1000个血小板/微升1.013；P=0.001）。为便于该模型在临床中的应用，开发了一个在线计算器，可在http://www.OldTMZ.com获取。
使用本研究建立的模型，可根据患者的年龄、性别和治疗前血小板计数估计替莫唑胺同步放化疗成功实施的概率。因此，可以识别出适合接受替莫唑胺放化疗的老年胶质母细胞瘤患者亚组。
