1 Faculty of Health Sciences, University of Hull , Hull , UK.
2 Queen centre of Oncology, Castle Hill hospital , Cottingham , UK.
Br J Radiol. 2018 Jul;91(1088):20170271. doi: 10.1259/bjr.20170271. Epub 2018 Mar 9.
The management of elderly patients with glioblastoma-multiforme (GBM) remains poorly defined with many experts in the past advocating best supportive care, in view of limited evidence on efficacy of more aggressive treatment protocols. There is randomised evidence (NORDIC and NA-O8 studies) to support the use of surgery followed by adjuvant monotherapy with either radiotherapy (RT) using hypofractionated regimes (e.g. 36 Gy in 6 fractions OR 40 Gy in 15 fractions) or chemotherapy with temozolomide (TMZ) in patients expressing methylation of promoter for O-methylguanine-DNA methyltransferase enzyme. However, the role of combined-modality therapy involving the use of combined RT and TMZ protocols has remained controversial with data from the EORTC (European Organisation for Research and Treatment of Cancer)-NCIC (National Cancer Institute of Canada) studies indicating that patients more than 65 years of age may not benefit significantly from combining standard RT fractionation using 60 Gy in 30 fractions with concurrent and adjuvant TMZ. More recently, randomised data has emerged on combining hypofractionated RT with concurrent and adjuvant TMZ. We provide a comprehensive review of literature with the aim of defining an evidence-based algorithm for management of elderly glioblastoma-multiforme population.
老年多形性胶质母细胞瘤（GBM）的管理仍未明确界定，鉴于更积极的治疗方案疗效的有限证据，过去许多专家都提倡最佳支持治疗。有随机证据（NORDIC 和 NA-O8 研究）支持在手术后使用辅助单一疗法，即使用分割放疗（例如 36 Gy 分 6 次或 40 Gy 分 15 次）或替莫唑胺（TMZ）化疗，用于表达 O-甲基鸟嘌呤-DNA 甲基转移酶酶启动子甲基化的患者。然而，涉及使用联合放疗和 TMZ 方案的联合治疗的作用仍存在争议，EORTC（欧洲癌症研究与治疗组织）-NCIC（加拿大国家癌症研究所）研究的数据表明，年龄超过 65 岁的患者可能不会从标准 RT 分割（60 Gy 分 30 次）与同步和辅助 TMZ 联合使用中显著受益。最近，出现了关于联合使用分割放疗和同步辅助 TMZ 的随机数据。我们提供了一份全面的文献综述，旨在为老年多形性胶质母细胞瘤人群的管理制定一个基于证据的算法。
