Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, 07061, South Korea.
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, 03080, South Korea.
J Neurooncol. 2020 May;148(1):57-65. doi: 10.1007/s11060-020-03468-x. Epub 2020 May 2.
The optimal radiotherapy regimen in elderly patients with glioblastoma treated by chemoradiation needs to be addressed. We provide the results of a comparison between conventionally fractionated standard radiotherapy (CRT) and short-course radiotherapy (SRT) in those patients treated by temozolomide-based chemoradiation.
Patients aged 65 years or older from the GBM-molRPA cohort were included. Patients who were planned for a ≥ 6-week or ≤ 4-week radiotherapy were regarded as being treated by CRT or SRT, respectively. The median RT dose in the CRT and SRT group was 60 Gy in 30 fractions and 45 Gy in 15 fractions, respectively.
A total of 260 and 134 patients aged older than 65 and 70 years were identified, respectively. CRT- and SRT-based chemoradiation was applied for 192 (73.8%) and 68 (26.2%) patients, respectively. Compared to SRT, CRT significantly improved MS from 13.2 to 17.6 months and 13.3 to 16.4 months in patients older than 65 years (P < 0.001) and 70 years (P = 0.002), respectively. Statistical significance remained after adjusting for age, performance status, surgical extent, and MGMT promoter methylation in both age groups. The benefit was clear in all subgroup analyses for patients with Karnofsky performance score 70-100, Karnofsky performance score ≤ 60, gross total resection, biopsy, methylated MGMT promoter, and unmethylated MGMT promoter (all P < 0.05).
CRT significantly improved survival compared to SRT in elderly glioblastoma patients treated with chemoradiation in selected patients amenable for chemoradiation. This study is hypothesis-generating and a prospective randomized trial is urgently warranted.
需要解决接受放化疗的老年胶质母细胞瘤患者的最佳放疗方案。我们提供了替莫唑胺为基础的放化疗中，常规分割标准放疗（CRT）和短程放疗（SRT）对比的结果。
从 GBM-molRPA 队列中纳入年龄在 65 岁或以上的患者。分别将计划接受≥6 周或≤4 周放疗的患者视为接受 CRT 或 SRT 治疗。CRT 和 SRT 组的中位放疗剂量分别为 60Gy/30 次和 45Gy/15 次。
分别确定了 260 名和 134 名年龄大于 65 岁和 70 岁的患者。192 名（73.8%）和 68 名（26.2%）患者分别接受了 CRT 和 SRT 为基础的放化疗。与 SRT 相比，CRT 显著改善了年龄大于 65 岁（P < 0.001）和 70 岁（P = 0.002）患者的中位总生存期（MS），从 13.2 个月提高到 17.6 个月和 13.3 个月。在两个年龄组中，调整年龄、表现状态、手术范围和 MGMT 启动子甲基化后，统计学意义仍然存在。在卡诺夫斯基表现评分为 70-100、卡诺夫斯基表现评分为≤60、大体全切除、活检、甲基化 MGMT 启动子和非甲基化 MGMT 启动子的所有亚组分析中，获益均明显（均 P < 0.05）。
在可接受放化疗的选择患者中，与 SRT 相比，CRT 显著提高了接受放化疗的老年胶质母细胞瘤患者的生存率。本研究是一个假设生成的研究，迫切需要进行前瞻性随机试验。
