Abstract
To assess the role of comorbidity on outcome in elderly patients with glioblastoma treated with radiotherapy plus concomitant and adjuvant Temozolomide, patients over 65 years with glioblastoma, who underwent surgical resection or biopsy and radiochemotherapy, were evaluated. The Adjusted-Age Charlson Comorbidity Index and the Adult Comorbidity Evaluation-27 were used to assess comorbidity. From April 2005 to January 2011, 35 patients (median age 72 years) were treated in our Institution. Thirteen patients had a Charlson score more than 3, while, according to the Adult Comorbidity Evaluation-27, 21 patients had mild or severe comorbid conditions. Patients with low Charlson comorbidity score experienced a longer survival time than those with higher score (22 vs. 10 months, respectively). The Adjusted-Age Charlson Comorbidity Index influenced survival at univariate and multivariate analysis (p = 0.004, p = 0.001, respectively). No comorbidity index was a predictor for progression-free survival. Our data suggested that the association of radiotherapy with TMZ was safe and effective. Perhaps, the comorbidity assessment could be an appropriate tool in the treatment decision for elderly patients with glioblastoma.
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References
DeAngelis LM. Brain tumors. N Engl J Med. 2001;344:114–23.
Stupp R, Mason W, Van der Bent M, et al. Radiotherapy plus concomitant and adjuvant Temozolomide for glioblastoma. N Engl J Med. 2005;352:987–96.
Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomized phase III study: 5-years analysis of the EORTC-NCIC trial. Lancet Oncol. 2009;10:459–66.
Fischer JL, et al. Epidemiology of brain tumors. Neurol Clin. 2007;25:867–90.
Curran WJ Jr, Scott CB, Horton J, et al. Recursive partitioning analysis of prognostic factors in three radiation therapy oncology group malignant glioma trials. J Natl Cancer Inst. 1993;85:704–10.
Simpson JR, Horton J, Scott C, et al. Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials. Int J Radiat Oncol Biol Phys. 2003;26:239–44.
Yovino S, Grossman SA. Treatment of glioblastoma in “elderly” patients. Curr Treat Opin Oncol. 2011;12:253–62.
Fiorentino A, Chiumento C, Caivano R et al. Adjuvant radiochemotherapy in elderly patients with Glioblastoma: single institution experience and review of the literature. Radiol Med. 2012 (in press).
Iwamoto FM, Cooper AR, Reiner AS, et al. Glioblastoma in elderly: the Memorial Sloan-Kettering Cancer Center experience (1997–2007). Cancer. 2009;16:3758–66.
Daskivich TJ, Chamie K, Kwan L, Labo J, Palvolgyi R, Dash A, Greenfield S, Litwin MS. Overtreatment of men with low-risk prostate cancer and significant comorbidity. Cancer. 2011;117(10):2058–66.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.
Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr. Prognostic importance of co-morbidity in a hospital-based cancer registry. J Am Med Assoc. 2004;291:2441–7.
Fiorica F, Berretta M, Colosimo C, et al. Glioblastoma in elderly patients: safety and efficacy of adjuvant radiotherapy with concomitant temozolomide. Arch Gerontol Geriatr. 2010;51(1):31–5.
Clogh-Gorr KM, Stuck AE, Thwin SS. Older breast cancer survivors: geriatric assessment domains are associated with poor tolerance of treatment adverse effects and predict mortality over 7 years of follow-up. J Clin Oncol. 2010;28(3):380–6.
Kopek N, Paludan M, Petersen J, Hansen AT, Grau C, Høyer M. Comorbidity index predicts for mortality after stereotacticbody radiotherapy for medical inoperable early stage non-small cell lung cancer. Radiother Oncol. 2009;93(3):402–7.
Fiorentino A, Chiesa S, De Bonis P et al. Impact of Temozolomide and Radiation Therapy in elderly patients affected by glioblastoma: A pooled analysis of 3 prospectic phase II trials. J Clin Oncol. 2010;28:7s (abstr 2070).
Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.
Balducci M, D’Agostino GR, Manfrida S, et al. Radiotherapy and concomitant temozolomide during the first and last weeks in high grade gliomas: long-term analysis of a phase II study. J Neurooncol. 2010;97(1):95–100.
Minniti G, Lanzetta G, Scaringi C et al. Phase II study of short-course radiotherapy plus adjuvant Temozolomide in elderly patients with glioblastoma. Int J Radiat Oncol Biol Phys. 2011. doi:10.1016/j.ijrobp.2011.06.1992.
Irminger-Finger I. Science of cancer and aging. J Clin Oncol. 1844;2007(25):51.
Gomez-Millan J. Radiation therapy in the elderly: more side effects and complications? Crit Rev Oncol Hematol. 2009;71:70–8.
Yancik R, Havlik RJ, Wesley MN, et al. Cancer and co-morbidity in older patients: a descriptive profile. Ann Epidemiol. 1996;6(5):399–412.
Djunic I, Virijevic M, Novkovic A et al. Comorbidity as a risk factor for overall survival and decision criteria for intensity of chemotherapy in elderly patients with acute myeloid leukemia. Med Oncol. 2011. doi:10.1007/s12032-011-9853-8.
Fiorica F, Berretta M, Colosimo C, et al. Safety and efficacy in radiotherapy treatment in elderly patients with localized prostate cancer: a retrospective analysis. Arch Geron Geriatr. 2010;51:277–82.
Peters TT, van der Laan BF, Plaat BE, Wedman J, Langendijk JA, Halmos GB. Impact of comorbidity on treatment-relate side effects in older patients with laryngeal cancer. Oral Oncol. 2011;47(1):56–61.
Chiumento C, Fiorentino A, Caivano R, Clemente S, Fusco V. Prostate low-dose rate Brachytherapy in elderly patients. Radiol Med. 2012 (in press).
Brandes AA, Franceschi E, Tosoni A, et al. Temozolomide concomitant and adjuvant to radiotherapy in elderly patients with glioblastoma: correlation with MGMT promoter methylation status. Cancer. 2009;115:3512–8.
Gerstein J, Franz K, Steinbach JP, et al. Postoperative radiotherapy and concomitant Temozolomide for elderly patients with glioblastoma. Radiother Oncol. 2010;97(3):382–6.
Keim-Guibert F, Chinot O, Taillandier L, et al. Radiotherapy for glioblastoma in elderly. N Engl J Med. 2007;356:1527–35.
Glantz M, Chamberlain M, Liu Q, Litofsky NS, Recht LD. Temozolomide as an alternative to irradiation for elderly patients with new diagnosed malignant gliomas. Cancer. 2003;97(9):2262–6.
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We gratefully acknowledge Filippo Fiorentino for his support in the revision of this manuscript.
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Fiorentino, A., Caivano, R., Chiumento, C. et al. Comorbidity assessment and adjuvant radiochemotherapy in elderly affected by glioblastoma. Med Oncol 29, 3467–3471 (2012). https://doi.org/10.1007/s12032-012-0246-4
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DOI: https://doi.org/10.1007/s12032-012-0246-4