Toxicity from chemoradiotherapy in older patients with glioblastoma multiforme

Sijben, Angelique; McIntyre, John B.; Roldán, Glòria; Easaw, Jacob C.; Yan, Elizabeth; Forsyth, Peter; Parney, Ian F.; Magliocco, Anthony M.; Bernsen, Hans J.; Cairncross, J. Gregory

doi:10.1007/s11060-008-9593-6

Cited by 125 publications

(91 citation statements)

References 33 publications

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“…31 Sijben et al reported that the MGMT gene promoter was hypermethylated in 13/29 (45%) cases in their series of 39 patients aged 65 or older. 21 Median OS and median progression-free survival (PFS) times were not statistically different for methylated (7.4 and 4.5 months, respectively) and unmethylated (7.3 and 5.5 months, respectively) cases. 21 Gerstner et al found that 37/64 (57.8%) patients aged 70 or older with GB had methylation of the MGMT promoter, similar to the rate of 44.7% seen in the EORTC-NCIC trial.…”

Section: Prognostic Factorsmentioning

confidence: 94%

“…21 Median OS and median progression-free survival (PFS) times were not statistically different for methylated (7.4 and 4.5 months, respectively) and unmethylated (7.3 and 5.5 months, respectively) cases. 21 Gerstner et al found that 37/64 (57.8%) patients aged 70 or older with GB had methylation of the MGMT promoter, similar to the rate of 44.7% seen in the EORTC-NCIC trial. 24,30 Age, extent of resection, KPS, and MGMT promoter methylation were associated with a reduced hazard for progression and death in a multivariate Cox model in this cohort of 64 elderly patients.…”

Section: Prognostic Factorsmentioning

confidence: 94%

“…4,21,[24][25][26][27] The RTOG recursive partitioning analysis from 1,578 patients entered in three RTOG malignant glioma trials did not include patients older than 70 years. 28 Lamborn and colleagues undertook a recursive partitioning analysis of prognostic factors for 832 patients with GB entered on non-brachytherapy trials with planned adjuvant chemotherapy.…”

Section: Prognostic Factorsmentioning

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%

See 3 more Smart Citations

Optimal management of elderly patients with glioblastoma

Laperrière¹,

Weller²,

Stupp³

et al. 2013

Cancer Treatment Reviews

136

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Section: Prognostic Factorsmentioning

confidence: 94%

Section: Prognostic Factorsmentioning

confidence: 94%

Section: Prognostic Factorsmentioning

confidence: 99%

Section: 31-34mentioning

confidence: 99%

See 2 more Smart Citations

Optimal management of elderly patients with glioblastoma

Laperrière¹,

Weller²,

Stupp³

et al. 2013

Cancer Treatment Reviews

136

View full text Add to dashboard Cite

“…That shorter os is likely multifactorial and reflects differing tumour biology in elderly patients, as well as differences in treatment patterns and tolerance of therapy [6][7][8] . Many elderly or frail patients are unable to tolerate combined chemoradiotherapy, and toxicities-including severe fatigue, myelosuppression, and infections-are common 9 . As a result, investigators have been led to explore alternative treatment strategies in older gbm patients, including hypofractionated radiotherapy 10,11 and temozolomide monotherapy 12 .…”

Section: Introductionmentioning

confidence: 99%

Treatment and Outcomes for Glioblastoma in Elderly Compared with Non-elderly Patients: A Population-Based Study

Norman

Laing

2017

Current Oncology

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Purpose Elderly patients make up a large percentage of the individuals newly diagnosed with glioblastoma (gbm), but they face particular challenges in tolerating standard therapy, and compared with younger patients, they experience significantly shorter survival. We set out to compare clinical characteristics, treatment patterns, and outcomes in a non-elderly group (<65 years) and an elderly group (≥65 years) of patients diagnosed with gbm.Methods This retrospective population-based study used a province-wide cancer registry to identify patients with a new diagnosis of gbm within a 6-year period (2006)(2007)(2008)(2009)(2010)(2011)(2012). Of the 138 patients identified, 56 (40.6%) were 65 years of age or older. Demographic characteristics, treatment patterns, and overall survival (os) in the elderly and non-elderly groups were compared. Predictors of os were determined using multivariate analysis.Results Elderly patients were more likely to present with a poor performance status (Eastern Cooperative Oncology Group ≥ 2), to undergo biopsy without resection, and to receive whole-brain or hypofractionated radiotherapy. Compared with non-elderly patients, the elderly patients were less likely to receive adjuvant temozolomide. Survival time was significantly shorter in the elderly than in the non-elderly patients (7.2 months vs. 11.2 months). In multivariate analysis, surgical resection, hypofractionated radiotherapy (compared with whole-brain or conventional radiotherapy), and chemotherapy were predictive of os in older patients. Among elderly patients receiving radiation, survival was improved with the use of combined therapy compared with the use of radiation only (11.3 months vs. 4.6 months). ConclusionsOverall survival was shorter for elderly patients with gbm than for non-elderly patients; the elderly patients were also less likely to receive intensive surgical or adjuvant therapy. Our population-based analysis demonstrated improved os with surgical resection, hypofractionated radiotherapy, and temozolomide, and supports the results of recent clinical trials demonstrating a benefit for combination chemoradiotherapy in older patients.

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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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Toxicity from chemoradiotherapy in older patients with glioblastoma multiforme

Cited by 125 publications

References 33 publications

Optimal management of elderly patients with glioblastoma

Optimal management of elderly patients with glioblastoma

Treatment and Outcomes for Glioblastoma in Elderly Compared with Non-elderly Patients: A Population-Based Study

Treatment of Elderly Patients With Glioblastoma

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