Welzel Grit, Gehweiler Julian, Brehmer Stefanie, Appelt Jens-Uwe, von Deimling Andreas, Seiz-Rosenhagen Marcel, Schmiedek Peter, Wenz Frederik, Giordano Frank A
Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.
Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.
J Neurooncol. 2015 Sep;124(2):265-73. doi: 10.1007/s11060-015-1834-x. Epub 2015 Jun 5.
Chemotherapy is often omitted in elderly patients with glioblastoma multiforme due to a fear of side effects. We applied metronomic chemotherapy with low-dose temozolomide and celecoxib (LD-TEM/CEL) during and after external beam radiotherapy (EBRT) and here report on how this regimen compares to standard temozolomide radiochemotherapy (SD-TEM) in elderly patients. We retrospectively analyzed records of 146 patients aged 65 years and older that underwent EBRT. Factors of interest were age, performance status, comorbidities, MGMT status, therapy (resection/biopsy, radiotherapy/dose, chemotherapy/regimen/dose), progression-free (PFS) and overall survival (OS) status. Irrespective of the regimen, addition of chemotherapy more than doubled median survival rates (EBRT only: 4.2 months; EBRT + LD-TEM/CEL: 8.5 months; EBRT + SD-TEM: 10.8 months; p ≤ 0.008). Although patients receiving metronomic LD-TEM/CEL were significantly older (62 % were ≥75 years vs. 22 %; p < 0.001), had significantly lower performance scores (50 % had a KPS <70 vs. 28 %; p = 0.049) and were significantly more comorbid (73 % had ≥4 comorbidities vs. 37 %; p = 0.002) than patients of the SD-TEM group, there were no significant differences in PFS and OS. Independent of other factors, omission of chemotherapy significantly impairs progression-free and overall survival. With all the limitations of a retrospective analysis, our data suggest that metronomic chemotherapy with LD-TEM/CEL may be equieffective and eventually better tolerated than SD-TEM. It may be offered to elderly patients that are not eligible for standard chemotherapy.
由于担心副作用，多形性胶质母细胞瘤老年患者常常不进行化疗。我们在体外照射放疗（EBRT）期间及之后应用了低剂量替莫唑胺和塞来昔布的节拍化疗（LD-TEM/CEL），在此报告该方案与老年患者标准替莫唑胺放化疗（SD-TEM）相比的情况。我们回顾性分析了146例65岁及以上接受EBRT患者的记录。感兴趣的因素包括年龄、体能状态、合并症、MGMT状态、治疗（切除/活检、放疗/剂量、化疗/方案/剂量）、无进展（PFS）和总生存（OS）状态。无论采用何种方案，添加化疗使中位生存率提高了一倍多（仅EBRT：4.2个月；EBRT + LD-TEM/CEL：8.5个月；EBRT + SD-TEM：10.8个月；p≤0.008）。尽管接受节拍LD-TEM/CEL治疗的患者年龄显著更大（62%≥75岁，而SD-TEM组为22%；p<0.001），体能评分显著更低（50%的KPS<70，而SD-TEM组为28%；p = 0.049），合并症显著更多（73%有≥4种合并症，而SD-TEM组为37%；p = 0.002），但PFS和OS无显著差异。与其他因素无关，不进行化疗会显著损害无进展生存期和总生存期。尽管回顾性分析存在所有局限性，但我们的数据表明，LD-TEM/CEL节拍化疗可能与SD-TEM疗效相当，且最终耐受性更好。它可用于不符合标准化疗条件的老年患者。
