Background Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumor in adults, and it is associated with a poor prognosis in the elderly. The current standard of care for newly diagnosed GBM is maximal surgical resection, followed by radiotherapy plus concomitant and adjuvant temozolomide (TMZ). In elderly patients with GBM, short-courses of radiotherapy with TMZ are used. Material and Methods We performed a single-center retrospective analysis of elderly GBM patients treated from 2013 to 2020. The primary endpoint was to evaluate progression free survival (PFS) and overall survival (OS) according to treatment received (TMZ and standard radiotherapy (60 Gy over a period of 6 weeks) vs TMZ and short-course radiotherapy (40 Gy in 15 fractions)). Secondary endpoints were analysis of population demographics and major toxicities associated to treatment. Results Twenty-two patients were identified. The median age was 72 years (range 65- 80), 18 (85.7%) patients were in ECOG-PS 0-1, 12 (57.1%) were males and all patients had undergone partial or complete resection surgery. Eleven (52.4%) patients received TMZ and standard radiotherapy and 10 (47.6%) patients received TMZ and short-course radiotherapy. Three (14.3%) patients had complete remission, 11 (52.4%) patients had partial response, 2 (9.5%) patients presented stable disease and 5 (23.8%) patients had disease progression. Median OS was 9 months (95% CI, 3.6 to 14.4) with TMZ with standard radiotherapy and 8 months (95% CI, 1.8 to 14.2) with TMZ and short-course radiotherapy (p=0.322). Median PFS was 5 months (95% CI, 2.8 to 7.2) with TMZ with standard radiotherapy and 6 months (95% CI, 3.1 to 8.9) with TMZ and short-course radiotherapy (p=0.944). Most common toxicities were hematological, with 5 (23.8%) patients presented thrombocytopenia grade 2 or higher. Five (23.8%) patients presented grade 3/4 toxicities (2 (9.5%) patients presented thrombocytopenia grade 4, 1 (4.8%) patient presented thrombocytopenia grade 3, and 2 (9.5%) patients presented anemia grade 3. Conclusion The prognosis of GBM remains poor besides standard therapy. TMZ and short-course radiotherapy should be an option in elderly patients due to its non-inferiority. Elderly patients should undergo a careful geriatric evaluation before starting treatment.
Purpose Significant changes in treatment centers were implemented during COVID-19 pandemics. Understanding how these alterations impacted cancer patients is a subject that needs to be investigated. Methods Patients who accepted to fill a hand paper questionnaire were included in this cross-sectional study. The questionnaire was distributed between March 19 and April 30, 2020 (first emergency state in Portugal) at the Portuguese Oncology Institute of Coimbra Francisco Gentil. Results A total of 100 patients participated in the study, of whom 66% were female. The median age was 61 years old [29–89]. Patients presented low education levels (65% with 9 or less years of schooling), lived together (83%) and were undergoing palliate treatments (59%). The most significant reported change in health care were inability of having an accompanying person in medical appointments (64%). Association with the level of education, household, type of solid cancer or therapeutic purpose was not verified (Creamer-V-indicator < 0.4). The major concerns reported were being infected by SARS-Cov-2 due to an immunosuppressed state (65%) and the security of self/family/friends (53%). Patients with lower education were more worried about developing COVID-19 (p = 0.001) and of having limited access to medical care (p = 0.047). Patients in a curative therapeutic approach were more concerned about employment situation (p = 0.031) and had higher anxiety levels (p = 0.047). Conclusion COVID-19 pandemic is having a great impact in patients with cancer, namely in those who have a lower education level, live alone or those who therapeutic approach is curative. The implementation of measures to manage the psychologic impact of COVID-19 is urgent.
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