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Journal of Neuro-Oncology

, Volume 128, Issue 1, pp 157–162 | Cite as

Which elderly newly diagnosed glioblastoma patients can benefit from radiotherapy and temozolomide? A PERNO prospective study

  • Enrico Franceschi
  • Roberta Depenni
  • Alexandro Paccapelo
  • Mario Ermani
  • Marina Faedi
  • Carmelo Sturiale
  • Maria Michiara
  • Franco Servadei
  • Giacomo Pavesi
  • Benedetta Urbini
  • Anna Pisanello
  • Girolamo Crisi
  • Michele A. Cavallo
  • Claudio Dazzi
  • Claudia Biasini
  • Federica Bertolini
  • Claudia Mucciarini
  • Giuseppe Pasini
  • Agostino Baruzzi
  • Alba A. BrandesEmail author
  • The PERNO Study Group
Clinical Study

Abstract

The role of temozolomide concurrent with and adjuvant to radiotherapy (RT/TMZ) in elderly patients with glioblastoma (GBM) remains unclear. We evaluated the outcome of patients >70 years in the context of the Project of Emilia-Romagna Region in Neuro-Oncology (PERNO), the first Italian prospective observational population-based study in neuro-oncology. For this analysis the criteria for selecting patients enrolled in the PERNO study were: age >70 years; PS 0–3; histologically confirmed GBM; postoperative radiotherapy (RT) after surgery with or without concomitant temozolomide (TMZ) or postsurgical TMZ alone. Between January 2009 and December 2010, 76 GBM elderly patients were identified in the prospective PERNO study. Twenty-three patients did not receive any treatment after surgery, and 53 patients received postsurgical treatments (25 patients received RT alone and 28 patients RT/TMZ). Median survival was 11.1 months (95 % CI 8.8–13.5), adding temozolomide concomitant and adjuvant to radiotherapy it was 11.6 months (95 % CI 8.6–14.6), and 9.3 months (95 % CI 8.1–10.6) in patients treated with RT alone (P = 0.164). However, patients with MGMT methylated treated with RT/TMZ obtained a better survival (17.2 months, 95 % CI 11.5–22.9) (P = 0.042). No difference in terms of survival were observed if patients with MGMT unmethylated tumor received RT alone, or RT/TMZ or, in MGMT methylated tumor, if patients received radiotherapy alone. In elderly patients RT/TMZ represent a widely used approach but it is effective with methylated MGMT tumors only.

Keywords

Glioblastoma Elderly MGMT methylation Temozolomide Radiotherapy 

Notes

Acknowledgments

The authors are indebted to Dr. Fiorenzo Albani and Dr. Roberto D’Alessandro (IRCCS Institute of Neurological Sciences, Bologna) and Dr. Rossana De Palma (Regional Agency for Health and Social Care of Emilia-Romagna Region) for the constructive criticism and for the continuous support given during and after the study.

Funding

This work was funded by a grant from the “Programma di Ricerca Regione-Università 2007-2010”, Project Emilia-Romagna in Neuro-Oncology (PERNO).

PERNO Study Group

Steering committee: Baruzzi A. (Chair); Albani F., Calbucci F., D’Alessandro R., Michelucci R. (IRCCS Institute of Neurological Sciences, Bologna, Italy); Brandes A. (Department of Medical Oncology, Bellaria-Maggiore Hospitals, Bologna, Italy); Eusebi V. (Department of Hematology and Oncological Sciences “L. & A. Seragnoli”, Section of Anatomic Pathology at Bellaria Hospital, Bologna, Italy); Ceruti S., Fainardi E., Tamarozzi R. (Neuroradiology Unit, Department of Neurosciences and Rehabilitation, S. Anna Hospital, Ferrara, Italy); Emiliani E. (Istituto Oncologico Romagnolo, Department of Medical Oncology, Santa Maria delle Croci Hospital, Ravenna, Italy); Cavallo M. (Division of Neurosurgery, Department of Neurosciences and Rehabilitation, S. Anna Hospital, Ferrara, Italy).

Executive committee: Franceschi E., Tosoni A. (Department of Medical Oncology, Bellaria-Maggiore Hospitals, Bologna, Italy); Cavallo M. (Division of Neurosurgery, Department of Neurosciences and Rehabilitation, S. Anna Hospital, Ferrara, Italy); Fiorica F. (Department of Radiation Oncology, S. Anna Hospital, Ferrara, Italy); Valentini A. (Division of Neurosurgery, Nuovo Ospedale Civile S. Agostino-Estense, Baggiovara, Modena, Italy); Depenni R. (Department of Oncology, Policlinico di Modena, Italy); Mucciarini C. (Department of Oncology, Ramazzini Hospital, Carpi, Modena, Italy); Crisi G. (Department of Neuroradiology, Maggiore Hospital, Parma, Italy); Sasso E. (Department of Neurological Sciences, Maggiore Hospital, Parma, Italy); Biasini C., Cavanna L. (Department of Oncology and Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy); Guidetti D. (Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy); Marcello N., Pisanello A. (Department of Neurology, Istituto in tecnologie avanzate e modelli assistenziali in oncologia, IRCCS, S. Maria Nuova Hospital, Reggio Emilia, Italy); Cremonini A.M., Guiducci G. (Division of Neurosurgery, M. Bufalini Hospital, Cesena, Italy).

Registry Coordination Office: de Pasqua S., Testoni S. (IRCCS Institute of Neurological Sciences, Bologna, Italy).

Participants: Agati R., Ambrosetto G., Bacci A., Baldin E., Baldrati A., Barbieri E., Bartolini S., Bellavista E., Bisulli F., Bonora E., Bunkheila F., Carelli V., Crisci M., Dall’Occa P., de Biase D., Ferro S., Franceschi C., Frezza G., Grasso V., Leonardi M., Marucci G., Morandi L., Mostacci B., Palandri G., Pasini E., Pastore Trossello M., Pession A., Poggi R., Riguzzi P., Rinaldi R., Rizzi S., Romeo G., Spagnolli F., Tinuper P., Trocino C. (Bologna); Dall’Agata M., Frattarelli M., Gentili G., Giovannini A., Iorio P., Pasquini U., Galletti G., Guidi C., Neri W., Patuelli A., Strumia S. (Forlì-Cesena); Faedi M., (IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori); Casmiro M., Gamboni A., Rasi F. (Faenza, RA); Cruciani G. (Lugo, RA); Cenni P., Dazzi C., Guidi A.R., Zumaglini F. (Ravenna); Amadori A., Pasini G., Pasquinelli M., Pasquini E., Polselli A., Ravasio A., Viti B. (Rimini); Sintini M. (Cattolica, RN); Ariatti A., Bertolini F., Bigliardi G., Carpeggiani P., Cavalleri F., Meletti S., Nichelli P., Pettorelli E., Pinna G., Zunarelli E. (Modena); Artioli F., Bernardini I., Costa M., Greco G., Guerzoni R., Stucchi C. (Carpi, MO); Iaccarino C., Ragazzi M., Rizzi R., Zuccoli G. (Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia); Api P., Cartei F., Colella M., Fallica E., Farneti M., Frassoldati A., Granieri E., Latini F., Monetti C., Saletti A., Schivalocchi R., Sarubbo S., Seraceni S., Tola M.R., Urbini B., Zini G. (Ferrara); Giorgi C., Montanari E. (Fidenza, PR); Cerasti D., Crafa P., Dascola I., Florindo I., Giombelli E., Mazza S., Ramponi V., Servadei F., Silini EM., Torelli P. (Parma); Immovilli P., Morelli N., Vanzo C. (Piacenza); Nobile C. (Padova).

Compliance with ethical standards

Conflict of Interest

None.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Enrico Franceschi
    • 1
  • Roberta Depenni
    • 2
  • Alexandro Paccapelo
    • 1
  • Mario Ermani
    • 3
  • Marina Faedi
    • 4
  • Carmelo Sturiale
    • 5
  • Maria Michiara
    • 6
  • Franco Servadei
    • 7
  • Giacomo Pavesi
    • 8
  • Benedetta Urbini
    • 9
  • Anna Pisanello
    • 10
  • Girolamo Crisi
    • 11
  • Michele A. Cavallo
    • 12
  • Claudio Dazzi
    • 13
  • Claudia Biasini
    • 14
  • Federica Bertolini
    • 2
  • Claudia Mucciarini
    • 15
  • Giuseppe Pasini
    • 16
  • Agostino Baruzzi
    • 17
    • 18
  • Alba A. Brandes
    • 1
    Email author
  • The PERNO Study Group
  1. 1.Department of Medical Oncology, Bellaria HospitalAzienda USL - IRCCS Institute of Neurological SciencesBolognaItaly
  2. 2.Department of Oncology, Hematology and Respiratory DiseasesUniversity Hospital of ModenaModenaItaly
  3. 3.Department of Neurosciences, Statistics and Informatics UnitAzienda Ospedale-UniversitàPaduaItaly
  4. 4.Department of Oncology and HematologyIstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) – IRCCSCesenaItaly
  5. 5.Department of Neurosurgery, Bellaria HospitalAzienda USL - IRCCS Institute of Neurological SciencesBolognaItaly
  6. 6.Department of Medical OncologyUniversity Hospital of ParmaParmaItaly
  7. 7.Department of NeurosurgeryUniversity Hospital of ParmaParmaItaly
  8. 8.Department of NeurosurgeryOspedale S. Agostino-EstenseModenaItaly
  9. 9.Clinical Oncology UnitSt Anna University HospitalFerraraItaly
  10. 10.Neurology UnitIRCCS-Arcispedale Santa Maria NuovaReggio EmiliaItaly
  11. 11.Department of NeuroradiologyUniversity Hospital of ParmaParmaItaly
  12. 12.Department of NeurosurgerySt Anna University HospitalFerraraItaly
  13. 13.Department of Oncology and HematologyGeneral HospitalRavennaItaly
  14. 14.Department of Oncology and Hematology, Oncology UnitAzienda Ospedaliera Guglielmo da SalicetoPiacenzaItaly
  15. 15.Medical Oncology UnitRamazzini HospitalCarpiItaly
  16. 16.Department of Medical OncologyInfermi HospitalRiminiItaly
  17. 17.IRCCS Institute of Neurological SciencesBolognaItaly
  18. 18.Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly

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