Glioblastoma multiforme of the elderly: the prognostic effect of resection on survival
Glioblastoma multiforme of the elderly: the prognostic effect of resection on survival
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DOI：
10.1007/s11060-010-0429-9
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发表时间：
2011-07-01
影响因子：
3.9
通讯作者：
Sabel, Michael
中科院分区：
文献类型：
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作者：
Ewelt, Christian;Goeppert, Mathias;Sabel, Michael
根据最近的发展，胶质母细胞瘤（GBM）的最佳治疗方案包括最大限度的安全切除和放疗（RT）和烷化剂化疗（CHX）的额外辅助治疗。这些选择已在中位年龄约为58岁的人群中进行了评价。因此，我们探讨了老年患者（> 65岁）是否也可以从细胞减灭术（CS）和使用烷化剂化疗的辅助治疗中获益。103例新诊断的原发性幕上多形性胶质母细胞瘤患者> 65岁（中位年龄70.8岁）在我们的单中心胶质瘤数据库中确定A组31例，单纯手术治疗B组（n = 37）：手术+放疗组（n = 18，CS n = 19）; C组（n = 35）：手术+放疗+CHX组（n = 4，CS n = 31）。确定各组的无进展生存期（PFS）和总生存期（OAS），并将其与年龄、Karnofsky评分（KPS）和切除程度（活检（BY）、部分（PR）和完全切除（CR））相关。根据Macdonald标准定义进展。所有患者的PFS和OAS分别为3.2个月和5.1个月（m）。A/B/C组的PFS和OAS分别为1.8/3.2/6.4 m（P = 0.000）和2.2/4.4/15.0 m（P = 0.000）。A/B/C组的中位年龄为74.4/70.6/68.5岁，中位KPS为60/70/80。年龄（< 75岁）与OAS呈负相关（5.8/2.5 m，P = 0.01）。KPS（< 70，千分之一70）与OAS 2.4/6.5 m相关（P = 0.000）。切除程度（BY、PR或CR）分别与PFS（2.1/3.4/6.4 m，P = 0，000）和OS（2.2/7.0/13.9 m，P = 0，000）相关。我们的研究表明，老年GBM患者可以受益于最大限度的治疗程序，细胞减灭显微手术，放射治疗和化疗。KPS和年龄明显影响治疗选择。在这一人群中，最令人印象深刻的预后预测因素是辅助放疗和化疗患者的显微手术切除程度。总之，老年GBM患者本身不应被排除在强化治疗程序之外。
According to recent developments the best treatment options for glioblastoma (GBM) consist in maximum safe resection and additional adjuvant treatment with radiotherapy (RT) and alkylating chemotherapy (CHX). These options have been evaluated for populations with a median age of approximately 58 years. We therefore addressed the issue of whether elderly patients (> 65years) could also benefit from cytoreductive surgery (CS) and adjuvant treatment using alkylating chemotherapy. One-hundred and three patients suffering from newly diagnosed, primary supratentorial glioblastoma multiforme > 65 years (median 70.8 years) were identified in our single-center glioma database (2002-2007) and retrospectively divided into group A (n = 31) treated with surgery alone (biopsy, BY, n = 21, CS n = 10), group B (n = 37) surgery plus radiation (BY n = 18, CS n = 19), and group C (n = 35) surgery, RT and CHX (BY n = 4, CS n = 31). Progression-free survival (PFS) and overall survival (OAS) were determined in each group and correlated to age, Karnofsky performance score (KPS), and extent of resection (biopsy (BY), partial (PR), and complete resection (CR)). Progression was defined according the Macdonald criteria. For all patients PFS and OAS were 3.2 months and 5.1 months (m) respectively. PFS and OAS for groups A/B/C were 1.8/3.2/6.4 m (P = 0.000) and 2.2/4.4/15.0 m (P = 0.000), respectively. Median age for groups A/B/C was 74.4/70.6/68.5 years and median KPS was 60/70/80. Age (< 75, a parts per thousand yen75) was inversely correlated with OAS (5.8/2.5 m, P = 0.01). KPS (< 70, a parts per thousand yen70) was correlated with OAS 2.4/6.5 m (P = 0.000). Extent of resection (BY, PR, or CR) correlated with PFS (2.1/3.4/6.4 m, P = 0,000) and OS (2.2/7.0/13.9 m, P = 0,000), respectively. Our study shows that elderly GBM patients can benefit from maximum treatment procedures with cytoreductive microsurgery, radiation therapy, and chemotherapy. Treatment options are obviously affected by KPS and age. The most impressive outcome predictor in this population was the extent of microsurgical resection for patients treated with adjuvant radiotherapy and chemotherapy. To conclude, elderly GBM patients should not be per se excluded from intensive treatment procedures.