Morgan E R, Norman A, Laing K, Seal M D
Gerry and Nancy Pencer Brain Tumour Centre, Princess Margaret Hospital Cancer Centre, Toronto, ON.
Cancer Care Program, Dr. H. Bliss Murphy Cancer Centre, St. John's, NL.
Curr Oncol. 2017 Apr;24(2):e92-e98. doi: 10.3747/co.24.3424. Epub 2017 Apr 27.
Elderly patients make up a large percentage of the individuals newly diagnosed with glioblastoma (gbm), but they face particular challenges in tolerating standard therapy, and compared with younger patients, they experience significantly shorter survival. We set out to compare clinical characteristics, treatment patterns, and outcomes in a non-elderly group (<65 years) and an elderly group (≥65 years) of patients diagnosed with gbm.
This retrospective population-based study used a province-wide cancer registry to identify patients with a new diagnosis of gbm within a 6-year period (2006-2012). Of the 138 patients identified, 56 (40.6%) were 65 years of age or older. Demographic characteristics, treatment patterns, and overall survival (os) in the elderly and non-elderly groups were compared. Predictors of os were determined using multivariate analysis.
Elderly patients were more likely to present with a poor performance status (Eastern Cooperative Oncology Group ≥ 2), to undergo biopsy without resection, and to receive whole-brain or hypofractionated radiotherapy. Compared with non-elderly patients, the elderly patients were less likely to receive adjuvant temozolomide. Survival time was significantly shorter in the elderly than in the non-elderly patients (7.2 months vs. 11.2 months). In multivariate analysis, surgical resection, hypofractionated radiotherapy (compared with whole-brain or conventional radiotherapy), and chemotherapy were predictive of os in older patients. Among elderly patients receiving radiation, survival was improved with the use of combined therapy compared with the use of radiation only (11.3 months vs. 4.6 months).
Overall survival was shorter for elderly patients with gbm than for non-elderly patients; the elderly patients were also less likely to receive intensive surgical or adjuvant therapy. Our population-based analysis demonstrated improved os with surgical resection, hypofractionated radiotherapy, and temozolomide, and supports the results of recent clinical trials demonstrating a benefit for combination chemoradiotherapy in older patients.
老年患者在新诊断的胶质母细胞瘤（GBM）患者中占很大比例，但他们在耐受标准治疗方面面临特殊挑战，并且与年轻患者相比，他们的生存期明显更短。我们着手比较非老年组（<65岁）和老年组（≥65岁）GBM患者的临床特征、治疗模式和预后。
这项基于人群的回顾性研究使用全省癌症登记处来识别在6年期间（2006 - 2012年）新诊断为GBM的患者。在确定的138例患者中，56例（40.6%）年龄在65岁及以上。比较了老年组和非老年组的人口统计学特征、治疗模式和总生存期（OS）。使用多变量分析确定OS的预测因素。
老年患者更有可能表现为较差的身体状况（东部肿瘤协作组≥2），接受活检而非切除手术，并接受全脑或大分割放疗。与非老年患者相比，老年患者接受辅助替莫唑胺治疗的可能性较小。老年患者的生存时间明显短于非老年患者（7.2个月对11.2个月）。在多变量分析中，手术切除、大分割放疗（与全脑或传统放疗相比）和化疗是老年患者OS的预测因素。在接受放疗的老年患者中，联合治疗与单纯放疗相比生存期有所改善（11.3个月对4.6个月）。
GBM老年患者的总生存期短于非老年患者；老年患者接受强化手术或辅助治疗的可能性也较小。我们基于人群的分析表明，手术切除、大分割放疗和替莫唑胺可改善OS，并支持近期临床试验的结果，即联合放化疗对老年患者有益。
