Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in elderly patients

Minniti, Giuseppe; Sanctis, Vitaliana De; Muni, R.; Filippone, F.; Bozzao, Alessandro; Valeriani, Maurizio; Osti, Mattia Falchetto; Paula, Ugo De; Lanzetta, Gaetano; Tombolini, Vincenzo; Enrici, Riccardo Maurizi

doi:10.1007/s11060-008-9538-0

Cited by 197 publications

(145 citation statements)

References 26 publications

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“…2,13,[21][22][23] So, these data lead one to question the use of approaches that are currently the standard of care in younger patients where there is more toxicity and less apparent benefit in terms of efficacy and overall survival in this older patient population.…”

Section: Discussionmentioning

confidence: 99%

“…They also looked at time There have been several small, uncontrolled, retrospective reports detailing the possible benefits and tolerability of the use of concurrent and adjuvant temozolomide with 6 weeks of RT in older patients with GB. 21,22,32,[48][49][50][51] These reports compare their results to historical controls or to the results of older reports in older patients with GB, with no accounting for the distribution of significant prognostic factors between these groups. Clearly the favorable outcomes in these reports could be related to the selection of patients with better prognostic factors and not related to more aggressive therapy with the full 6 week course of RT with concurrent and adjuvant temozolomide.…”

Section: 31-34mentioning

confidence: 99%

“…A few of these reports caution about the use of this 6-week course of chemo-RT in this elderly population in relation to an increased incidence of grade 3 or 4 hematologic toxicity and to a greater incidence of neurotoxicity. 21,22,32 The role of concomitant and adjuvant temozolomide in the elderly remains to be clarified, and the apparently improved survival in some uncontrolled series may in fact be related to the selection of patients with better prognostic factors.…”

Section: 31-34mentioning

confidence: 99%

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Optimal management of elderly patients with glioblastoma

Laperrière¹,

Weller²,

Stupp³

et al. 2013

Cancer Treatment Reviews

136

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Section: Discussionmentioning

confidence: 99%

Section: 31-34mentioning

confidence: 99%

Section: 31-34mentioning

confidence: 99%

See 1 more Smart Citation

Optimal management of elderly patients with glioblastoma

Laperrière¹,

Weller²,

Stupp³

et al. 2013

Cancer Treatment Reviews

136

View full text Add to dashboard Cite

“…In a small prospective study of 79 patients with glioblastoma ≥65 years of age, there was clear survival advantage of radiation followed by chemotherapy compared with radiation alone (overall survival, 14.9 versus 11.2 months) [22]. Another small prospective single-arm study of 32 glioblastoma patients aged ≥70 years with good performance status examined the effect of surgery, radiation, and concomitant and adjuvant temozolomide, similarly to the regimen done in younger patients [23]. The median overall survival was 10.6 months, but 28 % percent of the patients suffered from hematologic toxicity [23].…”

Section: Treatmentmentioning

confidence: 99%

“…Another small prospective single-arm study of 32 glioblastoma patients aged ≥70 years with good performance status examined the effect of surgery, radiation, and concomitant and adjuvant temozolomide, similarly to the regimen done in younger patients [23]. The median overall survival was 10.6 months, but 28 % percent of the patients suffered from hematologic toxicity [23]. We also recently reported on a retrospective study of 291 older patients with glioblastoma and combination of radiotherapy and temozolomide was an independent factor associated with prolonged survival in multivariate analyses [24].…”

Section: Treatmentmentioning

confidence: 99%

Primary Central Nervous System Tumors in the Aging Population

Iwamoto

2013

Curr Transl Geriatr Exp Gerontol Rep

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The incidence of primary brain tumors peaks in the aging population, and advanced age in often a prognostic factor associated with shorter survival. In the United States, it is estimated that 69,720 individuals will be diagnosed with primary CNS tumors in 2013, of which 24,560 are expected to be malignant and 45,160 non-malignant. Approximately 50 % of primary CNS tumors are expected to occur in individuals who are 65 years or older. Management of elderly patients with primary brain tumors is challenging because there is no accepted standard of care treatment and this population may have multiple comorbidities, decreased tolerance to treatment, and increased risk for radiation-induced neurotoxicity. This review gives an overview of the treatment options for older patients with glioblastoma and meningioma, the most common primary brain tumors in this population. Treatment of elderly patients with primary brain tumors needs to be individualized, and old age alone should not preclude the use of life-prolonging treatments.

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Treatment of Elderly Patients With Glioblastoma

et al. 2015

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IMPORTANCE Despite improvements in survival with aggressive chemoradiation, outcomes for patients diagnosed as having glioblastoma multiforme (GBM) remain poor. Survival is further limited in elderly patients, who are often unable to tolerate multimodality therapy. The appropriate treatment approach for elderly patients (aged >65 years) with GBM remains unclear. While the literature supports the use of standard radiotherapy (60 Gy), several recent studies have suggested that treatment with temozolomide monotherapy or short-course radiotherapy may be a reasonable alternative. OBJECTIVE To review literature reporting survival data related to treatment of elderly patients with GBM using either temozolomide alone or radiotherapy alone. EVIDENCE REVIEW We performed a systematic review to identify articles from the temozolomide era (2005-present) that reported survival data related to treatment of elderly patients with GBM using either temozolomide alone or radiotherapy alone, with consideration of O 6-methylguanine-DNA-methyltransferase gene (MGMT) promoter methylation status. PubMed was searched for articles between January 1, 2005, and August 31, 2013, using the search terms glioblastoma, elderly, temozolomide, radiation, hypofractionated, and survival, and references from relevant articles were searched. Selected articles reported overall survival data associated with either temozolomide alone or radiotherapy alone in elderly patients (aged Ն60 years) with GBM; articles were excluded if they did not report survival data from radiotherapy alone or temozolomide alone, were not restricted to an elderly population, did not report original data, were not restricted to patients with primary GBM, were a subgroup analysis of a prior article, were a case report, or could not be located in entirety. Articles were interrogated as per the criteria designated by the Oxford Centre for Evidence-Based Medicine to determine the level of evidence presented, and data from level 1 and 2 studies were used for analysis. From a review of 185 articles, 23 were selected for inclusion and final analysis. From these, we identified 2 level 1 studies and 1 level 2 study that reported overall survival in elderly patients treated with temozolomide alone, and 4 level 1 studies and 2 level 2 studies that reported overall survival in elderly patients treated with radiotherapy alone. FINDINGS This review of the literature revealed several limitations. First, there is a paucity of randomized clinical studies comparing temozolomide alone with radiotherapy alone in elderly patients with GBM. Second, there is a lack of coherence in the literature for the definition of elderly. Third, the treatment paradigms used are not consistent from study to study. Regardless, the available data did allow the formulation of a recommendation based on level 1 and 2 data. CONCLUSIONS AND RELEVANCE The literature supports the use of hypofractionated radiotherapy or temozolomide monotherapy in the treatment of elderly patients with GBM. In patients with MGMT promoter meth...

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Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in elderly patients

Abstract: Standard RT plus concomitant and adjuvant temozolomide is a feasible treatment for elderly patients with newly diagnosed glioblastoma who present with good prognostic factors.

Cited by 197 publications

References 26 publications

Optimal management of elderly patients with glioblastoma

Optimal management of elderly patients with glioblastoma

Primary Central Nervous System Tumors in the Aging Population

Treatment of Elderly Patients With Glioblastoma

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