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Published in: Strahlentherapie und Onkologie 2/2012

01-02-2012 | Original article

Radiotherapy with and without temozolomide in elderly patients with glioblastoma

Authors: M. Niyazi, S.B. Schwarz, B. Suchorska, C. Belka, M.D., Ph.D.

Published in: Strahlentherapie und Onkologie | Issue 2/2012

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Abstract

Background and purpose

The optimal treatment for elderly patients (age ≥ 70 years) with glioblastoma (GBM) remains controversial. We conducted a retrospective analysis in 43 consecutive elderly patients with glioblastoma who either underwent radiotherapy (RT) or radiotherapy plus concomitant temozolomide (TMZ).

Patients and methods

A total of 43 patients (≥ 70 years of age, median age 75.8 years) with newly diagnosed glioblastoma and a Karnofsky performance status (KPS) ≥ 70 were treated with RT alone (median 60 Gy in 2 Gy single fractions) or RT plus TMZ at a dose of 75 mg/m2 per day. The two groups were well-balanced; univariate (log-rank test) and multivariate Cox proportional hazards analysis were used to identify relevant prognostic factors.

Results

The median overall survival (mOS) of the entire patient cohort was 264 days (8.8 months) and the median progression-free survival (PFS) was 192 days (6.4 months). The factors age, sex, previous surgery, KPS, and concomitant use of TMZ had no significant influence on OS/PFS; multivariate analysis was performed to obtain adjusted hazard ratios. TMZ use resulted in a trend toward poorer overall survival when applied concomitantly (314 days compared to 192 days within the TMZ group, p = 0.106). The subgroup analysis revealed that TMZ use resulted in significantly worse survival rates in patients with KPS70 (p = 0.027), but for patients with KPS80 this difference was not detectable.

Conclusion

TMZ should only be used carefully in elderly patients with unfavorable KPS. In this patient cohort, radiotherapy alone is a reasonable option. Standard RT plus concomitant TMZ may be an advantageous treatment option for elderly patients with newly diagnosed glioblastoma who present with good prognostic factors.
Literature
1.
go back to reference Fleury A, Menegoz F, Grosclaude P et al (1997) Descriptive epidemiology of cerebral gliomas in France. Cancer 79:1195–1202PubMedCrossRef Fleury A, Menegoz F, Grosclaude P et al (1997) Descriptive epidemiology of cerebral gliomas in France. Cancer 79:1195–1202PubMedCrossRef
2.
go back to reference Chakrabarti I, Cockburn M, Cozen W et al (2005) A population-based description of glioblastoma multiforme in Los Angeles County, 1974–1999. Cancer 104:2798–2806PubMedCrossRef Chakrabarti I, Cockburn M, Cozen W et al (2005) A population-based description of glioblastoma multiforme in Los Angeles County, 1974–1999. Cancer 104:2798–2806PubMedCrossRef
3.
go back to reference 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 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
4.
go back to reference Meckling S, Dold O, Forsyth PA et al (1996) Malignant supratentorial glioma in the elderly: is radiotherapy useful? Neurology 47:901–905PubMedCrossRef Meckling S, Dold O, Forsyth PA et al (1996) Malignant supratentorial glioma in the elderly: is radiotherapy useful? Neurology 47:901–905PubMedCrossRef
5.
go back to reference 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, Compostella A, Blatt V, Tosoni A (2006) Glioblastoma in the elderly: current and future trends. Crit Rev Oncol Hematol 60:256–266PubMedCrossRef
6.
go back to reference Stupp R, Hegi ME, Mason WP et al (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10:459–466PubMedCrossRef Stupp R, Hegi ME, Mason WP et al (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10:459–466PubMedCrossRef
7.
go back to reference Stupp R, Mason WP, Bent MJ van den et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996PubMedCrossRef Stupp R, Mason WP, Bent MJ van den et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996PubMedCrossRef
8.
go back to reference Leitzen C, Schild HH, Bungart B et al (2011) Prediction of clinical course of glioblastomas by MRI during radiotherapy. Strahlenther Onkol 186:681–686CrossRef Leitzen C, Schild HH, Bungart B et al (2011) Prediction of clinical course of glioblastomas by MRI during radiotherapy. Strahlenther Onkol 186:681–686CrossRef
9.
go back to reference 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 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
10.
go back to reference Kopecky J, Priester P, Slovacek L et al (2010) Aplastic anemia as a cause of death in a patient with glioblastoma multiforme treated with temozolomide. Strahlenther Onkol 186:452–456PubMedCrossRef Kopecky J, Priester P, Slovacek L et al (2010) Aplastic anemia as a cause of death in a patient with glioblastoma multiforme treated with temozolomide. Strahlenther Onkol 186:452–456PubMedCrossRef
11.
go back to reference Fels F, Kraft JW, Grabenbauer GG (2010) Geriatrics and radiation oncology. part 1: how to identify high-risk patients and basic treatment principles. Strahlenther Onkol 186:411–422PubMedCrossRef Fels F, Kraft JW, Grabenbauer GG (2010) Geriatrics and radiation oncology. part 1: how to identify high-risk patients and basic treatment principles. Strahlenther Onkol 186:411–422PubMedCrossRef
12.
go back to reference Marijnen CAM, Berg SMP 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 Marijnen CAM, Berg SMP 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
13.
go back to reference Brandes AA, Vastola F, Basso U et al (2003) A prospective study on glioblastoma in the elderly. Cancer 97:657–662PubMedCrossRef Brandes AA, Vastola F, Basso U et al (2003) A prospective study on glioblastoma in the elderly. Cancer 97:657–662PubMedCrossRef
14.
go back to reference Armstrong TS, Gilbert MR (1996) Glial neoplasms: classification, treatment, and pathways for the future. Oncol Nurs Forum 23:615–625 (quiz 26–27)PubMed Armstrong TS, Gilbert MR (1996) Glial neoplasms: classification, treatment, and pathways for the future. Oncol Nurs Forum 23:615–625 (quiz 26–27)PubMed
15.
go back to reference Pierga JY, Hoang-Xuan K, Feuvret L et al (1999) Treatment of malignant gliomas in the elderly. J Neurooncol 43:187–193PubMedCrossRef Pierga JY, Hoang-Xuan K, Feuvret L et al (1999) Treatment of malignant gliomas in the elderly. J Neurooncol 43:187–193PubMedCrossRef
16.
go back to reference Piccirilli M, Bistazzoni S, Gagliardi FM et al (2006) Treatment of glioblastoma multiforme in elderly patients. Clinico-therapeutic remarks in 22 patients older than 80 years. Tumori 92:98–103PubMed Piccirilli M, Bistazzoni S, Gagliardi FM et al (2006) Treatment of glioblastoma multiforme in elderly patients. Clinico-therapeutic remarks in 22 patients older than 80 years. Tumori 92:98–103PubMed
17.
go back to reference 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 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
18.
go back to reference Kimple RJ, Grabowski S, Papez M et al (2010) Concurrent temozolomide and radiation, a reasonable option for elderly patients with glioblastoma multiforme? Am J Clin Oncol 33:265–270PubMed Kimple RJ, Grabowski S, Papez M et al (2010) Concurrent temozolomide and radiation, a reasonable option for elderly patients with glioblastoma multiforme? Am J Clin Oncol 33:265–270PubMed
19.
go back to reference Minniti G, De Sanctis V, Muni R et al (2009) Hypofractionated radiotherapy followed by adjuvant chemotherapy with temozolomide in elderly patients with glioblastoma. J Neurooncol 91:95–100PubMedCrossRef Minniti G, De Sanctis V, Muni R et al (2009) Hypofractionated radiotherapy followed by adjuvant chemotherapy with temozolomide in elderly patients with glioblastoma. J Neurooncol 91:95–100PubMedCrossRef
20.
go back to reference Gerstein J, Franz K, Eberlein K, Rodel C (2010) Radiotherapy with concomitant temozolomide in elderly patients with glioblastoma multiforme. Onkologie 33:56 Gerstein J, Franz K, Eberlein K, Rodel C (2010) Radiotherapy with concomitant temozolomide in elderly patients with glioblastoma multiforme. Onkologie 33:56
21.
go back to reference Fiorica F, Berretta M, Colosimo C et al (2009) Glioblastoma in elderly patients: safety and efficacy of adjuvant radiotherapy with concomitant temozolomide. Arch Gerontol Geriatr 51:31–35PubMedCrossRef Fiorica F, Berretta M, Colosimo C et al (2009) Glioblastoma in elderly patients: safety and efficacy of adjuvant radiotherapy with concomitant temozolomide. Arch Gerontol Geriatr 51:31–35PubMedCrossRef
22.
go back to reference 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 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
23.
go back to reference 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 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
24.
go back to reference Villa S, Vinolas N, Verger E et al (1998) Efficacy of radiotherapy for malignant gliomas in elderly patients. Int J Radiat Oncol Biol Phys 42:977–980PubMedCrossRef Villa S, Vinolas N, Verger E et al (1998) Efficacy of radiotherapy for malignant gliomas in elderly patients. Int J Radiat Oncol Biol Phys 42:977–980PubMedCrossRef
25.
go back to reference Glantz M, Chamberlain M, Liu Q et al (2003) Temozolomide as an alternative to irradiation for elderly patients with newly diagnosed malignant gliomas. Cancer 97:2262–2266PubMedCrossRef Glantz M, Chamberlain M, Liu Q et al (2003) Temozolomide as an alternative to irradiation for elderly patients with newly diagnosed malignant gliomas. Cancer 97:2262–2266PubMedCrossRef
26.
go back to reference Chinot OL, Barrie M, Frauger E et al (2004) Phase II study of temozolomide without radiotherapy in newly diagnosed glioblastoma multiforme in an elderly populations. Cancer 100:2208–2214PubMedCrossRef Chinot OL, Barrie M, Frauger E et al (2004) Phase II study of temozolomide without radiotherapy in newly diagnosed glioblastoma multiforme in an elderly populations. Cancer 100:2208–2214PubMedCrossRef
27.
go back to reference Chamberlain MC, Chalmers L (2007) A pilot study of primary temozolomide chemotherapy and deferred radiotherapy in elderly patients with glioblastoma. J Neurooncol 82:207–209PubMedCrossRef Chamberlain MC, Chalmers L (2007) A pilot study of primary temozolomide chemotherapy and deferred radiotherapy in elderly patients with glioblastoma. J Neurooncol 82:207–209PubMedCrossRef
28.
go back to reference Gerstein J, Franz K, Steinbach JP et al (2010) Postoperative radiotherapy and concomitant temozolomide for elderly patients with glioblastoma. Radiother Oncol 97:382–386PubMedCrossRef Gerstein J, Franz K, Steinbach JP et al (2010) Postoperative radiotherapy and concomitant temozolomide for elderly patients with glioblastoma. Radiother Oncol 97:382–386PubMedCrossRef
29.
go back to reference Gerstein J, Franz K, Steinbach J et al (2010) Combined radiochemotherapy with temozolomide in patients ≥ 65 years with multiform glioblastoma: clinical outcomes and prognostic factors. Strahlenther Onkol 186 (Sondernr 1):30CrossRef Gerstein J, Franz K, Steinbach J et al (2010) Combined radiochemotherapy with temozolomide in patients ≥ 65 years with multiform glioblastoma: clinical outcomes and prognostic factors. Strahlenther Onkol 186 (Sondernr 1):30CrossRef
30.
go back to reference 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, 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
31.
go back to reference Minniti G, De Sanctis V, Muni R et al (2008) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in elderly patients. J Neurooncol 88:97–103PubMedCrossRef Minniti G, De Sanctis V, Muni R et al (2008) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in elderly patients. J Neurooncol 88:97–103PubMedCrossRef
32.
go back to reference 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 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
33.
go back to reference Grabenbauer GG (2010) Long-term survival of patients with glioblastoma multiforme treated with chemoradiation: correlation with MGMT promoter methylation status. Strahlenther Onkol 186:185–187 Grabenbauer GG (2010) Long-term survival of patients with glioblastoma multiforme treated with chemoradiation: correlation with MGMT promoter methylation status. Strahlenther Onkol 186:185–187
Metadata
Title
Radiotherapy with and without temozolomide in elderly patients with glioblastoma
Authors
M. Niyazi
S.B. Schwarz
B. Suchorska
C. Belka, M.D., Ph.D.
Publication date
01-02-2012
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 2/2012
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-011-0026-7

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