Concurrent Temozolomide and Radiation, a Reasonable Option for Elderly Patients With Glioblastoma Multiforme?

Abstract

Concomitant daily temozolomide and radiation followed by adjuvant temozolomide is a tolerable and reasonable treatment option and has a good performance status for elderly patients diagnosed with glioblastoma.

Radiotherapy with and without temozolomide in elderly patients with glioblastoma

“…Our results on long-term radiotherapy ±TMZ in elderly patients ≥ 70 years are consistent with previous studies [13,14,15,16,17,18,19,20,21] and compare favorably with studies on the use of RT [3,22,23,24] or chemotherapy [25,26,27] alone. The most recent study of Gerstein et al [28,29] derived a more favorable outcome for irradiated patients concomitantly treated with TMZ with a median survival of 11.5 months compared to our 6.4 months.…”

“…A total of 43 patients were identified. As concomitant treatment, they either received concomitant TMZ (n = 18) or no additional substance (n = 25).…”

Hypofractionated radiotherapy with or without concurrent temozolomide in elderly patients with glioblastoma multiforme: a review of ten-year single institutional experience

“…The use of the Stupp regimen in elderly patients with glioblastoma has also been reported with median survivals in the range of 10.2-15.3 months, although no randomized comparisons against radiation alone are available (see Table 4) [20][21][22][23][24][25]. In the original Stupp protocol, patients between the ages of 50-70 (RPA class V) were included and median survival among this population was 10 months [8].…”

“…Taken together these studies suggest that primary chemotherapy may be a reasonable alternative to primary radiotherapy for this patient population. Gross total resection Reference a Hazard ratio for age is in terms of decades Table 4 Selected series of elderly (C60 years) glioblastoma multiforme patients treated with radiation and/or temozolomide [9,11,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Author More recently, two prospective Phase III randomized controlled trials comparing temozolomide alone in elderly GBM patients with standard-course RT and hypofractionated RT have been reported. The NOA-08 trial of the Neurooncology Working Group (NOA) of the German Cancer Society compared standard postsurgical involvedfield RT to a total dosage of 54 to 60 Gy in malignant glioma patients greater than 65 years with minimum KPS 60 to dose-intensified temozolomide alone (one week on/ one week off) [30].…”

Optimal management of elderly patients with glioblastoma

“…They also looked at time There have been several small, uncontrolled, retrospective reports detailing the possible benefits and tolerability of the use of concurrent and adjuvant temozolomide with 6 weeks of RT in older patients with GB. 21,22,32,[48][49][50][51] These reports compare their results to historical controls or to the results of older reports in older patients with GB, with no accounting for the distribution of significant prognostic factors between these groups. Clearly the favorable outcomes in these reports could be related to the selection of patients with better prognostic factors and not related to more aggressive therapy with the full 6 week course of RT with concurrent and adjuvant temozolomide.…”