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Open Access 01-12-2017 | Research

Does age really matter? Radiotherapy in elderly patients with glioblastoma, the Munich experience

Authors: Christoph Straube, Hagen Scherb, Jens Gempt, Stefanie Bette, Claus Zimmer, Friederike Schmidt-Graf, Jürgen Schlegel, Bernhard Meyer, Stephanie E. Combs

Published in: Radiation Oncology | Issue 1/2017

Abstract

Background

Glioblastoma is usually diagnosed around the age of 60–70 years. Patients older than 65 years are frequently described as “elderly”. Several trials with monotherapy have established treatment regimens that offer therapies with reduced side effects but reduced efficacy. We analysed the outcome of elderly glioblastoma patients treated at our facility.

Methods

We performed a retrospective analysis of 62 consecutive patients older than 65 years treated for a primary glioblastoma at our facility from 2009 to 2015.

Results

Median age was 69.6 years (range 65.1–85.6 years); median OS of the entire cohort was 10.9 months. ECOG, MGMT and extent of resection but not age and the time from surgery to radiotherapy were associated with longer survival. Patients treated with adjuvant chemotherapy had a significantly longer survival (20.5 vs. 7.8 months). Furthermore, salvage therapies were associated with significant improved survival when compared to Best Supportive Care (22.3 vs. 8.8 months).

Conclusion

Also elderly patients are likely to benefit from an aggressive treatment after primary diagnosis of glioblastoma.

Thakkar JP, Dolecek TA, Horbinski C, Ostrom QT, Lightner DD, Barnholtz-Sloan JS, Villano JL. Epidemiologic and molecular prognostic review of glioblastoma. Cancer Epidemiol Biomarkers Prev. 2014;23:1985–96. doi:10.1158/1055-9965.EPI-14-0275.CrossRefPubMedPubMedCentral

Wick W, Platten M, Meisner C, Felsberg J, Tabatabai G, Simon M, Nikkhah G, Papsdorf K, Steinbach JP, Sabel M, Combs SE, Vesper J, Braun C, Meixensberger J, Ketter R, Mayer-Steinacker R, Reifenberger G, Weller M. Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: The NOA-08 randomised, phase 3 trial. Lancet Oncol. 2012;13:707–15. doi:10.1016/S1470-2045(12)70164-X.CrossRefPubMed

Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJB, Belanger K, Brandes A a, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. The New England journal of medicine 2005; 352:987–96. doi: 10.1056/NEJMoa043330

Laperriere N, Weller M, Stupp R, Perry JR, Brandes AA, Wick W, van den Bent MJ. Optimal management of elderly patients with glioblastoma. Cancer Treat Rev. 2013;39:350–7. doi:10.1016/j.ctrv.2012.05.008.CrossRefPubMed

Sijben AE, McIntyre JB, Roldán GB, Easaw JC, Yan E, Forsyth PA, Parney IF, Magliocco AM, Bernsen H, Cairncross JG. Toxicity from chemoradiotherapy in older patients with glioblastoma multiforme. J Neuro-Oncol. 2008;89:97–103. doi:10.1007/s11060-008-9593-6.CrossRef

Iwamoto FM, Cooper AR, Reiner AS, Nayak L, Abrey LE. Glioblastoma in the elderly: The Memorial Sloan-Kettering Cancer Center experience (1997–2007). Cancer. 2009;115:3758–66. doi:10.1002/cncr.24413.CrossRefPubMed

Burton E, Ugiliweneza B, Woo S, Skirboll S, Boaky M. A surveillance, epidemiology and End results-Medicare data analysis of elderly patients with glioblastoma multiforme: treatment patterns, outcomes and cost. Mol Clin Oncol. 2015;3:971–8. doi:10.3892/mco.2015.590.PubMedPubMedCentral

Combs SE, Wagner J, Bischof M, Welzel T, Wagner F, Debus J, Schulz-Ertner D. Postoperative treatment of primary glioblastoma multiforme with radiation and concomitant temozolomide in elderly patients. Int J Radiat Oncol Biol Phys. 2008;70:987–92. doi:10.1016/j.ijrobp.2007.07.2368.CrossRefPubMed

Keime-Guibert F, Chinot O, Taillandier L, Cartalat-Carel S, Frenay M, Kantor G, Guillamo J-S, Jadaud E, Colin P, Bondiau P-Y, Meneï P, Loiseau H, Bernier V, Honnorat J, Barrié M, Mokhtari K, Mazeron J-J, Bissery A, Delattre J-Y. Radiotherapy for glioblastoma in the elderly. N Engl J Med. 2007;356:1527–35. doi:10.1056/NEJMoa065901.CrossRefPubMed

10.

Roa W, Brasher PM, Bauman G, Anthes M, Bruera E, Chan A, Fisher B, Fulton D, Gulavita S, Hao C, Husain S, Murtha A, Petruk K, Stewart D, Tai P, Urtasun R, Cairncross JG, Forsyth P. Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol. 2004;22:1583–8. doi:10.1200/JCO.2004.06.082.CrossRefPubMed

11.

Roa W, Kepka L, Kumar N, Sinaika V, Matiello J, Lomidze D, Hentati D, Guedes de Castro D, Dyttus-Cebulok K, Drodge S, Ghosh S, Jeremi B, Rosenblatt E, Fidarova E. International atomic energy agency randomized phase III study of radiation therapy in elderly and/or frail patients with newly diagnosed glioblastoma multiforme. J Clin Oncol. 2015. doi:10.1200/JCO.2015.62.6606.PubMed

12.

Perry JR, Laperriere N, O’Callaghan CJ, Brandes AA, Menten J, Phillips C, Fay M, Nishikawa R, Cairncross JG, Roa W, Osoba D, Rossiter JP, Sahgal A, Hirte H, Laigle-Donadey F, Franceschi E, Chinot O, Golfinopoulos V, Fariselli L, Wick A, Feuvret L, Back M, Tills M, Winch C, Baumert BG, Wick W, Ding K, Mason WP. Short-course radiation plus temozolomide in elderly patients with glioblastoma. N Engl J Med. 2017;376:1027–37. doi:10.1056/NEJMoa1611977.CrossRefPubMed

13.

Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, DeGroot J, Wick W, Gilbert MR, Lassman AB, Tsien C, Mikkelsen T, Wong ET, Chamberlain MC, Stupp R, Lamborn KR, Vogelbaum MA, Van Den Bent MJ, Chang SM. Updated response assessment criteria for high-grade gliomas: Response assessment in neuro-oncology working group. J Clin Oncol. 2010;28:1963–72. doi:10.1200/JCO.2009.26.3541.CrossRefPubMed

14.

Sacko A, Hou MM, Temgoua M, Alkhafaji A, Marantidou A, Belin C, Mandonnet E, Ursu R, Doridam J, Coman I, Levy-Piedbois C, Carpentier AF (2015) Evolution of the Karnosky Performance Status throughout life in glioblastoma patients. Journal of Neuro-Oncology 567–573. doi: 10.1007/s11060-015-1749-6

15.

Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, Ludwin SK, Allgeier A, Fisher B, Belanger K, Hau P, Brandes AA, Gijtenbeek J, Marosi C, Vecht CJ, Mokhtari K, Wesseling P, Villa S, Eisenhauer E, Gorlia T, Weller M, Lacombe D, Cairncross JG, Mirimanoff RO. 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. 2009;10:459–66. doi:10.1016/S1470-2045(09)70025-7.CrossRefPubMed

16.

Mirimanoff R-O, Gorlia T, Mason W, Van Den Bent MJ, Kortmann RD, Fisher B, Reni M, Brandes AA, Curschmann J, Villa S, Cairncross G, Allgeier A, Lacombe D, Stupp R. Radiotherapy and temozolomide for newly diagnosed glioblastoma: Recursive partitioning analysis of the EORTC 26981/22981-NCIC CE3 phase III randomized trial. J Clin Oncol. 2006;24:2563–9. doi:10.1200/JCO.2005.04.5963.CrossRefPubMed

17.

Malmström A, Grønberg BH, Marosi C, Stupp R, Frappaz D, Schultz H, Abacioglu U, Tavelin B, Lhermitte B, Hegi ME, Rosell J, Henriksson R. Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol. 2012;13:916–26. doi:10.1016/S1470-2045(12)70265-6.CrossRefPubMed

18.

Cao JQ, Fisher BJ, Bauman GS, Megyesi JF, Watling CJ, Macdonald DR. Hypofractionated radiotherapy with or without concurrent temozolomide in elderly patients with glioblastoma multiforme: A review of ten-year single institutional experience. J Neuro-Oncol. 2012;107:395–405. doi:10.1007/s11060-011-0766-3.CrossRef

19.

Baker H. Radiotherapy in the elderly and frail with glioblastoma. Lancet Oncol. 2015;16:e530. doi:10.1016/S1470-2045(15)00371-X.CrossRefPubMed

20.

Socha J, Kepka L, Ghosh S, Roa W, Kumar N, Sinaika V, Matiello J, Lomidze D, de Castro DG, Hentati D, Fidarova E. Outcome of treatment of recurrent glioblastoma multiforme in elderly and/or frail patients. J Neuro-Oncol. 2016;126:493–8. doi:10.1007/s11060-015-1987-7.CrossRef

21.

Sulman EP, Ismaila N, Armstrong TS, Tsien C, Batchelor TT, Cloughesy T, Galanis E, Gilbert M, Gondi V, Lovely M, Mehta M, Mumber MP, Sloan A, Chang SM. Radiation therapy for glioblastoma: American society of clinical oncology clinical practice guideline endorsement of the American society for radiation oncology guideline. J Clin Oncol. 2016;35:JCO2016707562. doi:10.1200/JCO.2016.70.7562.

Title: Does age really matter? Radiotherapy in elderly patients with glioblastoma, the Munich experience
Authors: Christoph Straube
Hagen Scherb
Jens Gempt
Stefanie Bette
Claus Zimmer
Friederike Schmidt-Graf
Jürgen Schlegel
Bernhard Meyer
Stephanie E. Combs
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2017
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-017-0809-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does age really matter? Radiotherapy in elderly patients with glioblastoma, the Munich experience

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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