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Adjuvant radiochemotherapy in the elderly affected by glioblastoma: single-institution experience and literature review

Radiochemioterapia adiuvante nei pazienti anziani affetti da glioblastoma: esperienza di un singolo istituto e revisione della letteratura

La radiologia medica volume 118, pages 870–881 (2013)Cite this article

Abstract

Purpose

Radiochemotherapy (RCT) is the standard adjuvant treatment for patients affected by glioblastoma (GBM). As there is no evidence in elderly patients with GBM, combined, single modality or best supportive care is used. The aim of this retrospective study was to evaluate acute toxicity and outcome of elderly patients with GBM treated with RCT with temozolomide (TMZ).

Materials and methods

Patients >65 years with newly diagnosed GBM who underwent surgery or biopsy and RCT were evaluated. Recursive Partitioning Analysis (RPA) class and National Cancer Institute — Common Toxicity Criteria (NCI-CTC) version 3 were used to classify patients and evaluate acute toxicity, respectively.

Results

From April 2005 to January 2011, 35 patients (18 women and 17 men) with GBM were treated at our institution. Only 31.43% of cases underwent complete resection. Median progression-free survival (PFS) was 8 months and median overall survival (OS) 13 months. At univariate and multivariate analysis, only RPA class correlated with OS (p=0.01, p=0.03, respectively). During RCT, toxicity was mild (thrombocytopaenia G3–4, 11.43%; neurological toxicity, G3–4, 8.57%).

Conclusions

Our data suggest that RCT with TMZ seems to produce a better outcome with a mild toxicity profile in elderly patients affected by GBM.

Riassunto

Obiettivo

La radiochemioterapia (RTCHT) è il trattamento standard nei pazienti affetti da glioblastoma (GBM), ma a causa della mancanza di evidenze nei pazienti anziani, la radioterapia e la chemioterapia possono essere utilizzate singolarmente o integrate. Il nostro studio retrospettivo valuta la tossicità acuta e l’outcome della RTCHT con temozolomide (TMZ) nei pazienti anziani affetti da GBM.

Materiali e metodi

Sono stati valutati pazienti con età superiore a 65anni affetti da GBM sottoposti a chirurgia o biopsia e RTCHT. I pazienti sono stati suddivisi secondo le classi prognostiche del radiation Therapy Oncology Group (RTOG)- recursive partitioning analysis (RPA). La tossicità acuta durante RTCHT è stata valutata secondo la scala National Cancer Institute-Common Toxicity Criteria (NCICTC) vers.3.

Risultati

Da aprile 2005 a gennaio 2011, 35 pazienti (18 donne e 17 uomini) sono stati trattati presso la nostra divisione. Solo 11 pazienti (31,43%) sono stati sottoposti a resezione completa. La sopravvivenza libera da progressione e la sopravvivenza mediane sono state di 8 e 13 mesi, rispettivamente. All’analisi univariata e multivariata solo la classe RPA ha mostrato influenzare la sopravvivenza (p=0,01; p=0,03). La tossicità acuta, durante RTCHT, è stata accettabile (11,43% di trombocitopenia G3–4; 8,57% di tossicità neurologica G3–4).

Conclusioni

I nostri dati suggeriscono che nei pazienti anziani l’associazione di radioterapia e temozolomide sembra essere efficace e sicura.

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Affiliations

  1. Department of Radiation Oncology, I.R.C.C.S.-C.R.O.B., Via S. Pio 1, 85028, Rionero in Vulture (PZ), Italy

    A. Fiorentino, C. Chiumento, R. Caivano, M. Cozzolino, P. Pedicini & V. Fusco

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  1. A. Fiorentino
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  2. C. Chiumento
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  3. R. Caivano
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  4. M. Cozzolino
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Correspondence to A. Fiorentino.

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Fiorentino, A., Chiumento, C., Caivano, R. et al. Adjuvant radiochemotherapy in the elderly affected by glioblastoma: single-institution experience and literature review. Radiol med 118, 870–881 (2013). https://doi.org/10.1007/s11547-012-0906-7

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Keywords

  • Glioblastoma
  • Radiotherapy
  • Elderly
  • Chemotherapy

Parole chiave

  • Glioblastoma
  • Radioterapia
  • Pazienti anziani
  • Chemioterapia