Division of Neurosurgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
Department of Pathophysiology and Organ Transplantation, Università degli Studi di Milano, Milan, Italy.
J Neurooncol. 2017 Sep;134(2):377-385. doi: 10.1007/s11060-017-2537-2. Epub 2017 Jul 6.
High grade gliomas (HGG) are tumors with a rapidly progressive course and the standard of care consists of surgery and chemo-radiotherapy. Elderly patients with HGG usually have a worse prognosis due to their comorbidities and difficulties in accessing or completing adjuvant treatments. The purpose of our study was to assess the influence of pre-operative factors (MMSE, age, sex, KPS, tumor volume) on the post-operative access to chemo-radiotherapy in the elderly population. In addition, the influence of the access to adjuvant therapies on overall survival (OS) was assessed. We retrospectively reviewed our consecutive case series of 117 elderly patients (≥65 years) with HGG treated in our Institution. All the clinical records regarding age, sex, tumor location, MMSE, KPS, access to adjuvant treatments and OS were analyzed. 72 males and 45 females with a median age of 71 years were analyzed. Adjuvant therapies were considered; concomitant chemo-radiotherapy with standard radiotherapy or hypofractionated radiation regimen. 84 patients had access to adjuvant therapies. Access to therapies was associated with a median age of 71(range 66-80) years, a median MMSE of 26(range 5-30), and a median tumor volume of 24 cm(range 1-140). The median OS was 13 months for patients who had access to adjuvant therapies and 5 months for patients who did not. In the elderly patients with HGG, the MMSE, age and tumor volume were predictive of post-surgery access to adjuvant treatments. OS was significantly longer in elderly patients with HGG who had access to post-surgery chemo-radiotherapy.
高级别胶质瘤（HGG）是一种具有快速进展过程的肿瘤，其标准治疗方法包括手术和放化疗。由于合并症和接受辅助治疗的困难，老年 HGG 患者的预后通常较差。我们的研究目的是评估术前因素（MMSE、年龄、性别、KPS、肿瘤体积）对老年人群术后接受放化疗的影响。此外，还评估了辅助治疗对总生存（OS）的影响。我们回顾性分析了在我院治疗的 117 例老年 HGG 患者（≥65 岁）的连续病例系列。分析了所有与年龄、性别、肿瘤部位、MMSE、KPS、辅助治疗的获得和 OS 相关的临床记录。共分析了 72 例男性和 45 例女性患者，中位年龄为 71 岁。考虑了辅助治疗；标准放疗或低分割放疗方案的同步放化疗。84 例患者接受了辅助治疗。治疗的获得与中位年龄 71 岁（范围 66-80 岁）、中位 MMSE 26 分（范围 5-30 分）和中位肿瘤体积 24cm3（范围 1-140cm3）相关。接受辅助治疗的患者中位 OS 为 13 个月，未接受辅助治疗的患者中位 OS 为 5 个月。在老年 HGG 患者中，MMSE、年龄和肿瘤体积是术后接受辅助治疗的预测因素。接受术后放化疗的老年 HGG 患者的 OS 明显更长。
