Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in elderly patients
Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in elderly patients
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DOI：
10.1007/s11060-008-9538-0
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发表时间：
2008-05-01
影响因子：
3.9
通讯作者：
Enrici, R. Maurizi
中科院分区：
文献类型：
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作者：
Minniti, G.;De Sanctis, V.;Enrici, R. Maurizi
目的对70岁以上的老年胶质母细胞瘤患者的最佳治疗方案仍存在争议。我们对连续32例老年胶质母细胞瘤患者进行了前瞻性试验，这些患者在手术后接受放射治疗(RT)，同时辅以替莫唑胺。患者和方法32例新诊断为胶质母细胞瘤，年龄在70岁以上，Karnofsky功能状态(KPS)和GT；=70的患者接受放射治疗(每日2次，每次2次，共60次)加替莫唑胺75 mg/m(2)，每日1次，然后辅以替莫唑胺(150~200 mg/m(2)，每28天为一个周期，共5天)。主要终点是总存活率(OS)。次要终点包括无进展生存期(PFS)和毒性。结果中位OS为10.6个月，中位PFS为7个月。6个月和12个月生存率分别为91%和37%。6个月和12个月的PFS率分别为56%和16%。在多因素分析中，KPS是唯一有意义的独立预后因素(P=0.01)。不良反应主要表现为神经毒性(40%)，大多数病例通过使用类固醇可以缓解，28%的患者出现3-4级血液毒性。停止化疗2例，延迟化疗9例，减少化疗4例。结论对于预后良好的老年初诊胶质母细胞瘤患者，标准RT联合替莫唑胺辅助化疗是一种可行的治疗方案。
Objectives The optimal treatment for elderly patients (age > 70 years) with glioblastoma remains controversial. We conducted a prospective trial in 32 consecutive elderly patients with glioblastoma who underwent surgery followed by radiotherapy (RT) plus concomitant and adjuvant temozolomide. Patients and Methods 32 patients 70 years of age or older with a newly diagnosed glioblastoma and a Karnofsky performance status (KPS) >= 70 were treated with RT (daily fractions of 2 Gy for a total of 60 Gy) plus temozolomide at the dose of 75 mg/m(2) per day followed by six cycles of adjuvant temozolomide (150-200 mg/m(2) for 5 days during each 28-day cycle). The primary endpoint was overall survival (OS). Secondary endpoints included progression free survival (PFS) and toxicity. Results The median OS was 10.6 months and the median PFS was 7 months. The 6-month and 12-month survival rates were 91% and 37%, respectively. The 6-month and 12-month PFS rates were 56% and 16%, respectively. In multivariate analysis KPS was the only significant independent predictive factor of survival (P = 0.01). Adverse effects were mainly represented by neurotoxicity (40%), which resolved in most cases with the use of steroids, and Grade 3-4 hematologic toxicity in 28% of patients. Chemotherapy was stopped in 2 patients, delayed in 9 patients and reduced in 4 patients. Conclusions Standard RT plus concomitant and adjuvant temozolomide is a feasible treatment for elderly patients with newly diagnosed glioblastoma who present with good prognostic factors.