Mohan D S, Suh J H, Phan J L, Kupelian P A, Cohen B H, Barnett G H
Department of Radiation Oncology, Cleveland Clinic Foundation, OH 44195, USA.
Int J Radiat Oncol Biol Phys. 1998 Dec 1;42(5):981-7. doi: 10.1016/s0360-3016(98)00296-x.
To determine the efficacy of definitive surgery and radiation in patients aged 70 years and older with supratentorial glioblastoma multiforme.
We selected elderly patients (> or = 70 years) who had primary treatment for glioblastoma multiforme at our tertiary care institution from 1977 through 1996. The study group (n = 102) included 58 patients treated with definitive radiation, 19 treated with palliative radiation, and 25 who received no radiation. To compare our results with published findings, we grouped our patients according to the applicable prognostic categories developed by the Radiation Therapy Oncology Group (RTOG): RTOG group IV (n = 6), V (n = 70), and VI (n = 26). Patients were retrospectively assigned to prognostic group IV, V, or VI based on age, performance status, extent of surgery, mental status, neurologic function, and radiation dose. Treatment included surgical resection and radiation (n = 49), biopsy alone (n = 25), and biopsy followed by radiation (n = 28). Patients were also stratified according to whether they were optimally treated (gross total or subtotal resection with postoperative definitive radiation) or suboptimally treated (biopsy, biopsy + radiation, surgery alone, or surgery + palliative radiation). Patients were considered to have a favorable prognosis (n = 39) if they were optimally treated and had a Karnofsky Performance Status (KPS) score of at least 70.
The median survival for patients according to RTOG groups IV, V, and VI was 9.2, 6.6, and 3.1 months, respectively (log-rank, p < 0.0004). The median overall survival was 5.3 months. The definitive radiation group (n = 58) had a median survival of 7.3 months compared to 4.5 months in the palliative radiation group (n = 19) and 1.2 months in the biopsy-alone group (p < 0.0001). Optimally treated patients had a median survival of 7.4 months compared to 2.4 months in those suboptimally treated (p < 0.0001). The favorable prognosis group had an 8.4-month median survival compared to 2.4 months in the unfavorable group (p < 0.0001). On multivariate analysis, the KPS, RTOG group, favorable/unfavorable prognosis, and optimal treatment/suboptimal treatment were significant predictors of survival.
Elderly patients with good performance status (> or = 70 KPS) when treated aggressively with maximal resection and definitive radiation had longer survival than those treated with palliative radiation and biopsy. Aggressive treatment in such patients should be considered.
确定手术根治和放疗对70岁及以上幕上多形性胶质母细胞瘤患者的疗效。
我们选取了1977年至1996年在我们三级医疗中心接受多形性胶质母细胞瘤初次治疗的老年患者（≥70岁）。研究组（n = 102）包括58例接受根治性放疗的患者、19例接受姑息性放疗的患者以及25例未接受放疗的患者。为了将我们的结果与已发表的研究结果进行比较，我们根据放射治疗肿瘤学组（RTOG）制定的适用预后类别对患者进行分组：RTOG IV组（n = 6）、V组（n = 70）和VI组（n = 26）。根据年龄、身体状况、手术范围、精神状态、神经功能和放疗剂量，将患者回顾性地分为预后IV组、V组或VI组。治疗包括手术切除和放疗（n = 49）、单纯活检（n = 25）以及活检后放疗（n = 28）。患者还根据是否接受了最佳治疗（大体全切或次全切除并术后根治性放疗）或非最佳治疗（活检、活检 + 放疗、单纯手术或手术 + 姑息性放疗）进行分层。如果患者接受了最佳治疗且卡诺夫斯基功能状态（KPS）评分至少为70分，则被认为预后良好（n = 39）。
根据RTOG IV组、V组和VI组，患者的中位生存期分别为9.2个月、6.6个月和3.1个月（对数秩检验，p < 0.0004）。总体中位生存期为5.3个月。根治性放疗组（n = 58）的中位生存期为7.3个月，而姑息性放疗组（n = 19）为4.5个月，单纯活检组为1.2个月（p < 0.0001）。接受最佳治疗的患者中位生存期为7.4个月，而非最佳治疗的患者为2.4个月（p < 0.0001）。预后良好组的中位生存期为8.4个月，而预后不良组为2.4个月（p < 0.0001）。多因素分析显示，KPS、RTOG组、预后良好/不良以及最佳治疗/非最佳治疗是生存的重要预测因素。
身体状况良好（KPS≥70）的老年患者，积极进行最大程度切除和根治性放疗，其生存期比接受姑息性放疗和活检的患者更长。对此类患者应考虑积极治疗。
