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Predictors of survival and effect of short (40 Gy) or standard-course (60 Gy) irradiation plus concomitant temozolomide in elderly patients with glioblastoma: a multicenter retrospective study of AINO (Italian Association of Neuro-Oncology)

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Abstract

The efficacy of temozolomide (TMZ) plus radiation therapy (RT) in elderly patients with glioblastoma is unclear. We performed a large multicenter retrospective study to analyze prognostic factors and clinical outcome in these patients. Inclusion criteria were age ≥65 years, newly histologically confirmed glioblastoma, ECOG PS 0-2, adjuvant treatment with RT plus TMZ. We enrolled 237 patients; the average age was 71 and ECOG PS was 0-1 in 196 patients; gross total resection was performed in 174 cases. MGMT was analyzed in 151 persons and was methylated in 56 %. IDH1 was assessed in 100 patients and was mutated in 6 %. Seventy-one patients were treated with RT 40 Gy and 166 with RT 60 Gy. Progression-free survival and overall survival (OS) were 11.3 and 17.3 months, respectively. Overall survival was 19.4 vs 13.8 months for patients treated with RT 60 Gy and 40 Gy (p = 0.02); OS was 17.7 versus 16.1 months for patients treated with gross total resection vs partial surgery (p = 0.02); OS was 21.2 versus 13.6 months for methylated and unmethylated MGMT (p < 0.001). On multivariate analysis, gross total resection, RT 60 Gy, methylated MGMT and ECOG PS 0-1 were independent predictors of longer survival. Twenty-five patients (10 %) had grade 3-4 haematological toxicity during the concomitant treatment. We showed that, in elderly patients in good clinical condition treated with concomitant treatment, standard-course irradiation might be more effective than short-course irradiation. Methylated MGMT remains the most important prognostic factor.

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Acknowledgments

This research was supported in part by “Ricerca Sanitaria Finalizzata of Veneto Region”. We thank Christina Drace for English support.

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Authors and Affiliations

  1. Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, via Gattamelata, 64, 35128, Padua, Italy

    Giuseppe Lombardi, Luisa Bellu, Ardi Pambuku & Vittorina Zagonel

  2. Neuro-Oncology Unit, “Regina Elena” National Cancer Institute, Rome, Italy

    Andrea Pace & Veronica Villani

  3. Department of Radiotherapy, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy

    Francesco Pasqualetti & Patrizia Ferrazza

  4. Department of Oncology, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy

    Simona Rizzato & Lorena Gurrieri

  5. Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Marina Faedi

  6. Unit of Molecular Neuro-Oncology, Fondazione I.R.C.C.S. Istituto Neurologico C. Besta, Milan, Italy

    Elena Anghileri & Marica Eoli

  7. Department of Neuro-Oncology, University of Turin and City of Health and Science, University Hospital, Turin, Italy

    Elisa Nicolotto & Roberta Rudà

  8. Department of Neurological and Movement Sciences, University of Verona, Verona, Italy

    Elena Bazzoli

  9. IRCCS, Centro S. Giovanni di Dio – Fatebenefratelli, Brescia, Italy

    Elena Bazzoli

  10. Division of Medical Oncology, “Regina Elena” National Cancer Institute, Rome, Italy

    Alessandra Fabi

  11. Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Monia Dall’Agata

  12. Neurosurgery Department, Azienda Ospedaliera di Padova, Padua, Italy

    Alessandro Della Puppa

  13. Neurosurgery Department, University of Padua, Padua, Italy

    Domenico D’Avella

  14. Radiation Therapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy

    Franco Berti

Authors
  1. Giuseppe Lombardi
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  2. Andrea Pace
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Correspondence to Giuseppe Lombardi.

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Lombardi, G., Pace, A., Pasqualetti, F. et al. Predictors of survival and effect of short (40 Gy) or standard-course (60 Gy) irradiation plus concomitant temozolomide in elderly patients with glioblastoma: a multicenter retrospective study of AINO (Italian Association of Neuro-Oncology). J Neurooncol 125, 359–367 (2015). https://doi.org/10.1007/s11060-015-1923-x

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