Lee Jessica W, Kirkpatrick John P, McSherry Frances, Herndon James E, Lipp Eric S, Desjardins Annick, Randazzo Dina M, Friedman Henry S, Ashley David M, Peters Katherine B, Johnson Margaret O
Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, United States.
Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, United States.
Front Oncol. 2021 Feb 25;11:631618. doi: 10.3389/fonc.2021.631618. eCollection 2021.
Standard 6-week and hypofractionated 3-week courses of adjuvant radiation therapy (RT) are both options for older patients with glioblastoma (GBM), but deciding the optimal regimen can be challenging. This analysis explores clinical factors associated with selection of RT course, completion of RT, and outcomes following RT.
This IRB-approved retrospective analysis identified patients ≥70 years old with GBM who initiated adjuvant RT at our institution between 2004 and 2016. We identified factors associated with standard or hypofractionated RT using the Cochran-Armitage trend test, estimated time-to-event endpoints using the Kaplan-Meier method, and found predictors of overall survival (OS) using Cox proportional hazards models.
Sixty-two patients with a median age of 74 (range 70-90) initiated adjuvant RT, with 43 (69%) receiving standard RT and 19 (31%) receiving hypofractionated RT. Selection of short-course RT was associated with older age (p = 0.04) and poor KPS (p = 0.03). Eight (13%) patients did not complete RT, primarily for hospice care due to worsening symptoms. After a median follow-up of 37 months, median OS was 12.3 months (95% CI 9.0-15.1). Increased age (p < 0.05), poor KPS (p < 0.0001), lack of MGMT methylation (p < 0.05), and lack of RT completion (p < 0.0001) were associated with worse OS on multivariate analysis. In this small cohort, GTV size and receipt of standard or hypofractionated RT were not associated with OS.
In this cohort of older patients with GBM, age and KPS was associated with selection of short-course or standard RT. These regimens had similar OS, though a subset of patients experienced worsening symptoms during RT and discontinued treatment. Further investigation into predictors of RT completion and survival may help guide adjuvant therapies and supportive care for older patients.
标准的6周辅助放疗疗程和短程分割的3周辅助放疗疗程都是老年胶质母细胞瘤（GBM）患者的选择，但确定最佳方案可能具有挑战性。本分析探讨了与放疗疗程选择、放疗完成情况及放疗后结局相关的临床因素。
这项经机构审查委员会批准的回顾性分析纳入了2004年至2016年间在我们机构开始辅助放疗的年龄≥70岁的GBM患者。我们使用 Cochr an-Armitage趋势检验确定与标准或短程分割放疗相关的因素，使用Kaplan-Meier方法估计事件发生时间终点，并使用Cox比例风险模型确定总生存期（OS）的预测因素。
62例中位年龄为74岁（范围70 - 90岁）的患者开始辅助放疗，其中43例（69%）接受标准放疗，19例（31%）接受短程分割放疗。选择短程放疗与年龄较大（p = 0.04）和KPS较差（p = 0.03）相关。8例（13%）患者未完成放疗，主要是由于症状恶化而接受临终关怀。中位随访37个月后，中位OS为12.3个月（95%CI 9.0 - 15.1）。多因素分析显示，年龄增加（p < 0.05）、KPS较差（p < 0.0001）、MGMT未甲基化（p < 0.05）以及未完成放疗（p < 0.0001）与较差的OS相关。在这个小队列中，GTV大小以及接受标准或短程分割放疗与OS无关。
在这个老年GBM患者队列中，年龄和KPS与短程或标准放疗的选择相关。这些方案的OS相似，尽管一部分患者在放疗期间症状恶化并中断治疗。进一步研究放疗完成和生存的预测因素可能有助于指导老年患者的辅助治疗和支持性护理。
