Juravinski Cancer Center, Department of Oncology, Radiation Oncology, McMaster University, 699 Concession St., Hamilton, ON L8V5C2, Canada.
Curr Oncol. 2021 Jun 26;28(4):2399-2408. doi: 10.3390/curroncol28040220.
(1) Background: Studies in elderly patients over the age of 65 with glioblastoma have shown survival benefits of short-course radiation therapy with concurrent and adjuvant temozolomide, making it the standard of care adopted at Juravinski Cancer Center. Our study retrospectively examines patients with GBM aged ≥ 70 at the JCC treated with short-course radiation alone compared to those treated with short-course radiation and concurrent and adjuvant TMZ, to determine if there is a difference in outcomes based on performance status. (2) Methods: A retrospective chart review was conducted at JCC using patients diagnosed with GBM in 2014-2017 (treated with the old protocol of short-course RT alone) versus those diagnosed in 2017-2019 (treated with the new protocol of short-course radiation and TMZ). Patient demographics, treatments, outcomes, and baseline KPS were analyzed. (3) Results: No clear benefit and more neurologic decline post treatment were seen in patients with borderline performance status and subtotal resection who underwent concurrent treatment with temozolomide and radiation. The addition of temozolomide was most helpful in patients with good performance status and a gross total resection. Variable outcomes were seen in patients with mixed traits. (4) Conclusions: This study suggests that performance status and extent of resection are significant determinants of patient response to treatment. In the case of elderly patients with borderline performance status and GTR or those with good performance status and STR, also described as "mixed traits", it may be beneficial to pursue single modality treatment, ideally based on MGMT promoter methylation status as opposed to bimodality treatment in order to maintain the best QOL.
(1)背景:研究表明,对于年龄在 65 岁以上的老年胶质母细胞瘤患者,短程放疗联合替莫唑胺辅助治疗可延长生存期,使其成为朱拉文斯基癌症中心(Juravinski Cancer Center)采用的标准治疗方法。本研究回顾性分析了朱拉文斯基癌症中心年龄在 70 岁及以上的 GBM 患者,这些患者单独接受短程放疗与同时接受短程放疗和替莫唑胺辅助治疗相比,基于功能状态,其结局是否存在差异。(2)方法:本研究在朱拉文斯基癌症中心采用回顾性图表审查方法,使用 2014 年至 2017 年(接受短程 RT 单独治疗的旧方案)诊断为 GBM 的患者与 2017 年至 2019 年(接受短程放疗和 TMZ 联合治疗的新方案)诊断为 GBM 的患者进行对比。分析患者的人口统计学特征、治疗方法、结局以及基线 KPS。(3)结果:在功能状态边缘性和次全切除的患者中,同时接受替莫唑胺和放疗治疗的患者,未见明确获益且治疗后神经功能恶化更明显。替莫唑胺辅助治疗对功能状态良好和大体全切除的患者最有帮助。混合特征的患者存在不同的结局。(4)结论:本研究表明,功能状态和切除程度是患者对治疗反应的重要决定因素。对于功能状态边缘性和 GTR 的老年患者或功能状态良好和 STR 的患者,也称为“混合特征”,进行单模态治疗可能有益,理想情况下,这种治疗应该基于 MGMT 启动子甲基化状态,而不是双模态治疗,以保持最佳的 QOL。