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Strahlentherapie und Onkologie

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01-06-2013 | Original article

Short-course radiotherapy in elderly patients with glioblastoma: feasibility and efficacy of results from a single centre

Authors: L. Fariselli, V. Pinzi, I. Milanesi, A. Silvani, M. Marchetti, M. Farinotti, A. Salmaggi

Published in: Strahlentherapie und Onkologie | Issue 6/2013

Abstract

Background

The incidence of glioblastoma (GBM) in the elderly population is currently increasing, with a peak seen between 65 and 84 years. The optimal treatment in terms of both efficacy and quality of life still remains a relevant and debated issue today.

The purpose of our study was to evaluate the feasibility of short-course hypofractionated accelerated radiotherapy (HART) in GBM patients aged over 70 years and with a good Karnofsky performance score (KPS).

Methods

A review of medical records at the “Istituto Neurologico C. Besta” was undertaken; patients aged ≥ 70 years who had undergone adjuvant HART for GBM between January 2000 and January 2004 were included in the study. HART was administered to a total dose of 45 Gy, 2.5 Gy/fraction, in three daily fractions for three consecutive days/cycle fractions each, delivered in two cycles (split 15 days).

Results

A total of 33 patients were evaluable for the current analysis. Median follow-up was 10 months. According to CTCAE (version 3.0) criteria, none of the patients developed radiation-induced neurological status deterioration or necrosis. KPS evaluation after HART was found to be stable in 73 % of patients, improved in 24 %, and worse in 3 %.

The median overall survival time of the entire study population was 8 months (range 2–24).

Conclusions

Our findings suggest that a hypofractionated accelerated schedule can be a safe and effective option in the treatment of GBM in the elderly.

American cancer society. Brain and spinal cord tumors in adults. http://www.cancer.org/cancer/braincnstumorsinadults/detailedguide/brain-and-spinal-cord-tumors-in-adults (Online)

Brandes AA, Compostella A, Blatt V, Tosoni A (2006) Glioblastoma in the elderly: current and future trends. Crit Rev Oncol Hematol 60:256–266PubMedCrossRef

Brandes AA, Franceschi E, Tosoni A et al (2009) Temozolomide concomitant and adjuvant to radiotherapy in elderly patients with glioblastoma: correlation with MGMT promoter methylation status. Cancer 115:3512–3518PubMedCrossRef

Brandes AA, Rigon A, Monfardini S (2000) Radiotherapy of the brain in elderly patients. Contra. Eur J Cancer 36:447–451PubMedCrossRef

Brandes AA, Vastola F, Basso U et al (2003) A prospective study on glioblastoma in the elderly. Cancer 97:657–662PubMedCrossRef

Budach W, Gioioso D, Taghian A et al (1997) Repopulation capacity during fractionated irradiation of squamous cell carcinomas and glioblastomas in vitro. Int J Radiat Oncol Biol Phys 39:743–750PubMedCrossRef

Cao JQ, Fisher BJ, Bauman GS et al (2011) Hypofractionated radiotherapy with or without concurrent temozolomide in elderly patients with glioblastoma multiforme: a review of ten-year single institutional experience. J Neurooncol 107:395–405PubMedCrossRef

Chang EL, Yi W, Allen PK et al (2003) Hypofractionated radiotherapy for elderly or younger low-performance status glioblastoma patients: outcome and prognostic factors. Int J Radiat Oncol Biol Phys 56:519–528PubMedCrossRef

Combs SE, Wagner J, Bischof M et al (2008) Postoperative treatment of primary glioblastoma multiforme with radiation and concomitant temozolomide in elderly patients. Int J Radiat Oncol Biol Phys 70:987–992PubMedCrossRef

10.

Cooper-Kuhn CM, Kuhn HG (2002) Is it all DNA repair? Methodological considerations for detecting neurogenesis in the adult brain. Brain Res Dev Brain Res 134:13–21PubMedCrossRef

11.

Curran WJ Jr, Scott CB, Horton J et al (1993) Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst 85:704–710PubMedCrossRef

12.

Filippini G, Falcone C, Boiardi A et al (2008) Prognostic factors for survival in 676 consecutive patients with newly diagnosed primary glioblastoma. Neuro Oncol 10:79–87PubMedCrossRef

13.

Gállego Pérez-Larraya J, Ducray F, Chinot O et al (2011) Temozolomide in elderly patients with newly diagnosed glioblastoma and poor performance status: an ANOCEF phase II trial. J Clin Oncol 29:3050–3055CrossRef

14.

Gerstein J, Franz K, Steinbach JP et al (2011) Radiochemotherapy with temozolomide for patients with glioblastoma. Prognostic factors and long-term outcome of unselected patients from a single institution. Strahlenther Onkol 187:722–728PubMedCrossRef

15.

Grau JJ, Verger E (2000) Radiotherapy of the brain in elderly patients. Pro:. Eur J Cancer 36:443–447PubMedCrossRef

16.

Greig NH, Ries LG, Yancik R, Rapoport SI (1990) Increasing annual incidence of primary malignant brain tumors in the elderly. J Natl Cancer Inst 82:1621–1624PubMedCrossRef

17.

Guckenberger M, Mayer M, Buttmann M et al (2011) Prolonged survival when temozolomide is added to accelerated radiotherapy for glioblastoma multiforme. Strahlenther Onkol 187:548–554PubMedCrossRef

18.

Hess KR, Broglio KR, Bondy ML (2004) Adult glioma incidence trends in the United States, 1997–2000. Cancer 101:2293–2299PubMedCrossRef

19.

Hoegler DB, Davey P (1997) A prospective study of short course radiotherapy in elderly patients with malignant glioma. J Neurooncol 33:201–204PubMedCrossRef

20.

Hoffman S, Propp JM, McCarthy BJ (2006) Temporal trends in incidence of primary brain tumors in the United States, 1985–1999. Neuro Oncol 8:27–37PubMedCrossRef

21.

Horiot JC, Bogaert W van de, Ang KK et al (1988) European organization for research on treatment of cancer trials using radiotherapy with multiple fractions per day. A 1978–1987 survey. Front Radiat Ther Oncol 22:149–161PubMed

22.

Idbaih A, Taillibert S, Simon JM et al (2008) Short course of radiation therapy in elderly patients with glioblastoma multiforme. Cancer Radiother 12:788–792PubMedCrossRef

23.

Iliadis G, Selviaridis P, Kalogera-Fountzila A et al (2009) The importance of tumor volume in the prognosis of patients with glioblastoma: comparison of computerized computer and geometric models. Strahlenther Onkol 185:743–750PubMedCrossRef

24.

International Commission on Radiation Units and Measurements (1993) Prescribing, recording and reporting photon beam therapy. Report 50, Bethesda, MD: ICRU

25.

International Commission on Radiation Units and Measurements (1999) Prescribing, recording and reporting photon beam therapy. Report 62 (Supplement to ICRU Report 50) Bethesda, MD: ICRU

26.

Iwamoto FM, Cooper AR, Reiner AS et al (2009) Glioblastoma in the elderly: the memorial Sloan-Kettering cancer center experience (1997–2007). Cancer 115:3758–3766PubMedCrossRef

27.

Iwamoto FM, Reiner AS, Panageas KS et al (2008) Patterns of care in elderly glioblastoma patients. Ann Neurol 64:628–634PubMedCrossRef

28.

Levin VA, Maor MH, Thall PF et al (1995) Phase II study of accelerated fractionation radiation therapy with carboplatin followed by vincristine chemotherapy for the treatment of glioblastoma multiforme. Int J Radiat Oncol Biol Phys 33:357–364PubMedCrossRef

29.

Keim H, Potthoff PC, Schmidt K et al (1987) Survival and quality of life after continuous accelerated radiotherapy of glioblastomas. Radiother Oncol 9:21–26PubMedCrossRef

30.

Keime-Guibert F, Chinot O, Taillandier L et al (2007) Radiotherapy for glioblastoma in the elderly. N Engl J Med 356:1527–1535PubMedCrossRef

31.

Kita D, Ciernik IF, Vaccarella S et al (2009) Age as a predictive factor in glioblastomas: population-based study. Neuroepidemiology 33:17–22PubMedCrossRef

32.

Lamborn KR, Chang SM, Prados MD (2004) Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro Oncol 6:227–235PubMedCrossRef

33.

Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280PubMed

34.

Meckling S, Dold O, Forsyth PA et al (1996) Malignant supratentorial glioma in the elderly: is radiotherapy useful? Neurology 47:901–905PubMedCrossRef

35.

Marijnen CA, Berg SM van den, Duinen SG van et al (2005) Radiotherapy is effective in patients with glioblastoma multiforme with a limited prognosis and in patients above 70 years of age: a retrospective single institution analysis. Radiother Oncol 75:210–216PubMedCrossRef

36.

Minniti G, Lanzetta G, Scaringi C et al (2012) Phase II study of short-course radiotherapy plus concomitant and adjuvant temozolomide in elderly patients with glioblastoma. Int J Radiat Oncol Biol Phys 83:93–99PubMedCrossRef

37.

Mohan DS, Suh JH, Phan JL et al (1998) Outcome in elderly patients undergoing definitive surgery and radiation therapy for supratentorial glioblastoma multiforme at a tertiary care institution. Int J Radiat Oncol Biol Phys 42:981–987PubMedCrossRef

38.

Newall J, Ransohoff J, Kaplan B (1988) Glioblastoma in the older patient: how long a course of radiotherapy is necessary? J Neurooncol 6:325–327PubMedCrossRef

39.

Nieder C, Andratschke N, Wiedenmann N et al (2004) Radiotherapy for high-grade gliomas. Does altered fractionation improve the outcome? Strahlenther Onkol 180:401–407PubMedCrossRef

40.

Niyazi M, Schwarz SB, Suchorska B, Belka C (2012) Radiotherapy with and without temozolomide in elderly patients with glioblastoma. Strahlenther Onkol 188:154–159PubMedCrossRef

41.

Nobusawa S, Watanabe T, Kleihues P, Ohgaki H (2009) IDH1 mutations as molecular signature and predictive factor of secondary glioblastomas. Clin Cancer Res 15:6002–6007PubMedCrossRef

42.

Pierga JY, Hoang-Xuan K, Feuvret L et al (1999) Treatment of malignant gliomas in the elderly. J Neurooncol 43:187–193PubMedCrossRef

43.

Piroth MD, Pinkawa M, Holy R et al (2012) Integrate boost IMRT with FET-PET-adapted local dose escalation in glioblastomas. Results of a prospective phase II study. Strahlenther Onkol 188:334–339PubMedCrossRef

44.

Roa W, Brasher PM, Bauman G et al (2004) Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol 22:1583–1588PubMedCrossRef

45.

Scott CB, Scarantino C, Urtasun R et al (1998) Validation and predictive power of Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis classes for malignant glioma patients: a report using RTOG 90–06. Int J Radiat Oncol Biol Phys 40:51–55PubMedCrossRef

46.

Scott JC, Suh JH, Elson P et al (2011) Aggressive treatment is appropriate for glioblastoma multiforme patients 70 years old or older: a retrospective review of 206 cases. Neuro Oncol 13:428–436PubMedCrossRef

47.

Scott JG, Bauchet L, Fraum TJ et al (2012) Recursive partitioning analysis of prognostic factors for glioblastoma patients aged 70 years or older. Cancer 118:5595–5600PubMedCrossRef

48.

Simpson JR, Horton J, Scott C et al (1993) Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials. Int J Radiat Oncol Biol Phys 26:239–244PubMedCrossRef

49.

Terasaki M, Eto T, Nakashima S et al (2011) A pilot study of hypofractionated radiation therapy with temozolomide for adults with glioblastoma multiforme. J Neurooncol 102:247–253PubMedCrossRef

50.

Vuorinen V, Hinkka S, Färkkilä M, Jaaskelainen J (2003) Debulking or biopsy of malignant glioma in elderly people—a randomised study. Acta Neurochir (Wien) 145:5–10

51.

National cancer institute: cancer therapy evaluation program. http://ctep.cancer.gov/forms/ctcaev3.pdf. (Online)

52.

Whittle IR, Basu N, Grant R et al (2002) Management of patients aged > 60 years with malignant glioma: good clinical status and radiotherapy determine outcome. Br J Neurosurg 16:343–347PubMedCrossRef

53.

Whittle IR, Denholm SW, Gregor A (1991) Management of patients aged over 60 years with supratentorial glioma: lessons from an audit. Surg Neurol 36:106–111PubMedCrossRef

54.

Zhang LY, Chen LS, Sun R et al (2012) Effects of expression level of DNA repair-related genes involved in the NHEJ pathway on radiation-induced cognitive impairment. J Radiat Res (Epub ahead of print)

Title: Short-course radiotherapy in elderly patients with glioblastoma: feasibility and efficacy of results from a single centre
Authors: L. Fariselli
V. Pinzi
I. Milanesi
A. Silvani
M. Marchetti
M. Farinotti
A. Salmaggi
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: Strahlentherapie und Onkologie / Issue 6/2013
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-013-0346-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Short-course radiotherapy in elderly patients with glioblastoma: feasibility and efficacy of results from a single centre

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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