Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-23T17:18:14.726Z Has data issue: false hasContentIssue false
  • English
  • Français

Glioblastoma Treatment in the Elderly in the Temozolomide Therapy Era

Published online by Cambridge University Press:  23 September 2014

Linda Coate ,
Mairéad G. McNamara ,
Zarnie Lwin ,
Derek MacFadden ,
Ahmed Al-Zahrani ,
Christine Massey ,
Cynthia Menard ,
Barbara Ann Millar ,
Arjun Sahgal  and
Normand Laperriere
...Show all authors
Linda Coate
Affiliation:
Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada Mid-Western Regional Hospital Limerick, Limerick, Ireland
Mairéad G. McNamara
Affiliation:
Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Zarnie Lwin
Affiliation:
Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada Department of Medical Oncology, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia
Derek MacFadden
Affiliation:
Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Ahmed Al-Zahrani
Affiliation:
Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada Department of Medical Oncology, King Faisal Cancer Center, Riyadh, Saudi Arabia
Christine Massey
Affiliation:
Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Cynthia Menard
Affiliation:
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Barbara Ann Millar
Affiliation:
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Arjun Sahgal
Affiliation:
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Normand Laperriere
Affiliation:
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Warren P. Mason*
Affiliation:
Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
*
*Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, 610 University Avenue, Suite 18-717, Toronto, Ontario, M5G 2M9, Canada. Email: warren.mason@uhn.ca
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Optimal treatment of glioblastoma (GBM) in the elderly remains unclear. The impact of age on treatment planning, toxicity, and efficacy at a Canadian Cancer Centre was retrospectively reviewed.

Methods:

Glioblastoma patients treated consecutively between 2004 and 2008 were reviewed. Utilizing 70 years as the threshold for definition of an elderly patient, treatments and outcome were compared in younger and elderly populations.

Results:

Four hundred and twenty one patients were included in this analysis and median overall survival (OS) for the entire cohort was 9.8 months. 290 patients were aged <70 (median age 57, range 17–69) and 131 were aged ≥70 (median age 76, range 70–93). Patients ≥70 were more likely to receive best supportive care (BSC) and all patients >70 who were treated with radiotherapy received <60 Gy (P<0.001), except one. Patients aged >70 demonstrated inferior survival (one year OS 16% versus 54% for those <70, HR 3.46, P<0.001). In patients treated with BSC only, age had no impact on survival (median survival two months in both groups, HR 0.89, P=0.75). For those treated with higher doses of radiotherapy (>30 Gy to <60 Gy), one year survival was 19% versus 24% in patients aged >70 versus <70 (HR 1.47, P=0.02) respectively.

Conclusions:

In this retrospective single institution series, elderly patients were more likely to be treated with BSC or palliative doses of radiotherapy. Randomized phase III study results are required for guidance in treatment of this population of patients.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 3 , May 2014 , pp. 357 - 362
Copyright
Copyright © The Canadian Journal of Neurological 2014

References

1.Wen, PY, Kesari, S. Malignant gliomas in adults. N Engl J Med. 2008 359(8)492507.Google Scholar
2.Fisher, JL, Schwartzbaum, JA, Wrensch, M, Wiemels, JL. Epidemiology of brain tumors. Neurol Clin. 2007 25(4)86790.Google Scholar
3.Hess, KR, Broglio, KR, Bondy, ML. Adult glioma incidence trends in the United States, 1977–2000. Cancer. 2004 101(10)22939.Google Scholar
4.Sahebjam, S, McNamara, M, Mason, WP. Management of glioblastoma in the elderly. Clin Adv Hematol Oncol. 2012 10(6)37986.Google Scholar
5.Buckner, JC. Factors influencing survival in high-grade gliomas. Semin Oncol. 2003 30(6)1014.Google Scholar
6.Scott, JG, Bauchet, L, Fraum, TJ. Recursive partitioning analysis of prognostic factors for glioblastoma patients aged 70 years or older. Cancer. 2012 118(22)5595600.Google Scholar
7.Keime-Guibert, F, Chinot, O, Taillandier, L. Radiotherapy for glioblastoma in the elderly. N Engl J Med. 2007 356(15)152735.Google Scholar
8.Walker, MD, Alexander, E Jr, Hunt, WE. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg. 1978 49(3)33343.Google Scholar
9.Lutterbach, J, Ostertag, C. What is the appropriate radiotherapy protocol for older patients with newly diagnosed glioblastoma?. J Clin Oncol. 2005 23(12)286970.Google Scholar
10.Roa, W, Brasher, PM, Bauman, G. Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol. 2004 22(9)15838.Google Scholar
11.Stupp, R, Mason, WP, van den Bent, MJ. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005 352(10)98796.Google Scholar
12.Stupp, R, Hegi, ME, Mason, WP. 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(5)45966.Google Scholar
13.National Institutes of Health webpage. Everolimus, temozolomide, and radiation therapy in treating patients with newly diagnosed glioblastoma multiforme (RTOG 0913). [updated 2013 Oct 3; cited 2013 Nov 1]. Available from: www.ClinicalTrials.gov Identifier: NCT01062399.Google Scholar
14.National Institutes of Health webpage. Radiation therapy with or without temozolomide in treating older patients with newly diagnosed glioblastoma multiforme. [updated 2013 May 22; cited 2013 Nov 1]. Available from: www.ClinicalTrials.gov Identifier: NCT00482677.Google Scholar
15.Malmstrom, A, Gronberg, BH, Marosi, C. 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(9)91626.Google Scholar
16.Minniti, G, De Sanctis, V, Muni, R. Hypofractionated radiotherapy followed by adjuvant chemotherapy with temozolomide in elderly patients with glioblastoma. J Neurooncol. 2009 91(1)95100.Google Scholar
17.Brandes, AA, Vastola, F, Basso, U. A prospective study on glioblastoma in the elderly. Cancer. 2003 97(3)65762.Google Scholar
18.Minniti, G, De Sanctis, V, Muni, R. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in elderly patients. J Neurooncol. 2008 88(1)97103.Google Scholar
19.Minniti, G, Lanzetta, G, Scaringi, C. Phase II study of short-course radiotherapy plus concomitant and adjuvant temozolomide in elderly patients with glioblastoma. Int J Radiat Oncol Biol Phys. 2012 83(1)939.Google Scholar
20.Wick, W, Platten, M, Meisner, C. Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Oncol. 2012 13(7)70715.Google Scholar