Department of Radiation Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
Department of Pathology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
World Neurosurg. 2022 May;161:e587-e595. doi: 10.1016/j.wneu.2022.02.059. Epub 2022 Feb 19.
There is lack of consensus regarding optimal adjuvant therapy in elderly glioblastoma (GBM). We have been treating elderly (≥60 years) GBM patients with normofractionated or hypofractionated radiotherapy (RT) plus temozolomide (TMZ) based on Karnofsky performance status (KPS). Herein we report clinical outcomes in this cohort treated at our institute using this approach.
Medical records of elderly GBM patients (≥60 years) treated between 2013 and 2017 with either normofractionated RT (59.4-60 Gy/30-33 fractions/6-6.5 weeks) or hypofractionated RT (35 Gy/10 fractions/2 weeks) plus TMZ were reviewed retrospectively. Outcomes of interest included progression-free survival (PFS), overall survival (OS), and ≥grade 3 myelotoxicity. Time-to-event outcomes were analyzed with Kaplan-Meier methods, compared using log-rank test, and reported as point estimates with 95% confidence interval (CI).
The normofractionated cohort (n = 126) was characterized by a higher proportion of patients younger than age 65 years, KPS ≥70, methylated O-methylguanine DNA methyltransferase (MGMT), and receiving adjuvant TMZ including extended adjuvant TMZ (>6 cycles) compared with the hypofractionated cohort (n = 20), confirming selection bias. At a median follow-up of 13 months, 1-year Kaplan-Meier estimates of PFS and OS were 43% (95% CI: 36%-52%) and 56% (95% CI: 48%-64%), yielding median PFS and OS of 11.0 months and 13.1 months, respectively. Higher KPS, methylated MGMT, normofractionated RT, and extended adjuvant TMZ emerged as favorable prognostic factors. TMZ was well tolerated with a low risk of ≥grade 3 myelotoxicity.
Our single-institution clinical audit confirms poor survival in elderly GBM with suboptimal performance status but demonstrates acceptably fair outcomes in patients with preserved KPS comparable with the nonelderly cohort.
在老年胶质母细胞瘤（GBM）患者中，对于最佳辅助治疗方法仍存在争议。我们基于卡氏行为状态评分（KPS），对老年（≥60 岁）GBM 患者采用常规分割或大分割放疗（RT）加替莫唑胺（TMZ）进行治疗。在此，我们报告了在本机构使用该方法治疗的这一组患者的临床结果。
回顾性分析了 2013 年至 2017 年间接受常规分割 RT（59.4-60 Gy/30-33 次/6-6.5 周）或大分割 RT（35 Gy/10 次/2 周）加 TMZ 治疗的老年 GBM 患者（≥60 岁）的病历。主要研究终点包括无进展生存期（PFS）、总生存期（OS）和≥3 级骨髓抑制。采用 Kaplan-Meier 方法分析时间依赖的生存数据，对数秩检验比较，并以点估计值和 95%置信区间（CI）报告。
与大分割组（n=20）相比，常规分割组（n=126）的患者更年轻（＜65 岁）、KPS 评分更高（≥70）、MGMT 甲基化、接受辅助 TMZ 治疗（包括延长辅助 TMZ（＞6 个周期））的比例更高。中位随访 13 个月时，1 年的 PFS 和 OS 的 Kaplan-Meier 估计值分别为 43%（95%CI：36%-52%）和 56%（95%CI：48%-64%），PFS 和 OS 的中位数分别为 11.0 个月和 13.1 个月。较高的 KPS、MGMT 甲基化、常规分割 RT 和延长辅助 TMZ 是有利的预后因素。TMZ 耐受性良好，≥3 级骨髓抑制的风险较低。
本单机构临床审计证实，老年 GBM 患者的一般状况不佳，生存较差，但对于 KPS 保留较好的患者，其结果与非老年患者相当，可接受。
