Department of Radiation Oncology, Institut de Cancérologie de l'Ouest (ICO), Boulevard J. Monod, 44805, Nantes-Saint-Herblain, France.
Department of Medical Oncology, Institut de Cancérologie de l'Ouest (ICO), Nantes-Saint-Herblain, France.
Sci Rep. 2021 Nov 11;11(1):22057. doi: 10.1038/s41598-021-01537-3.
Glioblastoma (GBM) is frequent in elderly patients, but their frailty provokes debate regarding optimal treatment in general, and the standard 6-week chemoradiation (CRT) in particular, although this is the mainstay for younger patients. All patients with newly diagnosed GBM and age ≥ 70 who were referred to our institution for 6-week CRT were reviewed from 2004 to 2018. MGMT status was not available for treatment decision at that time. The primary endpoint was overall survival (OS). Secondary outcomes were progression-free survival (PFS), early adverse neurological events without neurological progression ≤ 1 month after CRT and temozolomide hematologic toxicity assessed by CTCAE v5. 128 patients were included. The median age was 74.1 (IQR: 72-77). 15% of patients were ≥ 80 years. 62.5% and 37.5% of patients fulfilled the criteria for RPA class I-II and III-IV, respectively. 81% of patients received the entire CRT and 28% completed the maintenance temozolomide. With median follow-up of 11.7 months (IQR: 6.5-17.5), median OS was 11.7 months (CI 95%: 10-13 months). Median PFS was 9.5 months (CI 95%: 9-10.5 months). 8% of patients experienced grade ≥ 3 hematologic events. 52.5% of patients without neurological progression had early adverse neurological events. Post-operative neurological disabilities and age ≥ 80 were not associated with worsened outcomes. 6-week chemoradiation was feasible for "real-life" elderly patients diagnosed with glioblastoma, even in the case of post-operative neurological disabilities. Old does not necessarily mean worse.
胶质母细胞瘤（GBM）在老年患者中较为常见，但由于虚弱，关于其治疗方案存在争议，特别是标准的 6 周放化疗（CRT），因为这种方案常用于年轻患者。2004 年至 2018 年，我们机构对所有新诊断为 GBM 且年龄≥70 岁并接受 6 周 CRT 的患者进行了回顾性分析。当时，MGMT 状态对治疗决策没有影响。主要终点是总生存期（OS）。次要终点是无进展生存期（PFS）、CRT 后 1 个月内无神经进展的早期不良神经事件，以及根据 CTCAE v5.128 评估的替莫唑胺血液学毒性。共纳入 128 例患者。中位年龄为 74.1 岁（IQR：72-77）。15%的患者年龄≥80 岁。62.5%和 37.5%的患者分别符合 RPA Ⅰ-Ⅱ级和Ⅲ-Ⅳ级标准。81%的患者接受了完整的 CRT，28%的患者完成了维持性替莫唑胺治疗。中位随访时间为 11.7 个月（IQR：6.5-17.5），中位 OS 为 11.7 个月（95%CI：10-13 个月）。中位 PFS 为 9.5 个月（95%CI：9-10.5 个月）。8%的患者发生了≥3 级血液学事件。52.5%的无神经进展患者发生了早期不良神经事件。术后神经功能障碍和年龄≥80 岁与预后恶化无关。6 周放化疗对诊断为胶质母细胞瘤的“真实世界”老年患者是可行的，即使在术后出现神经功能障碍的情况下也是如此。老并不一定意味着更差。
