High-grade glioma in elderly patients: can the oncogeriatrician help?

Tabouret, Émeline; Tassy, Louis; Chinot, Olivier; Crétel, E.; Rétornaz, F.; Rousseau, Frédérique

doi:10.2147/cia.s35941

Cited by 4 publications

(4 citation statements)

References 66 publications

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“…In this study, we found that the radiation-induced hippocampal vascular injury and the subsequent neurocognitive decline are age- and sex- dependent. Although the exact mechanism of the age-dependent radiosensitivity remained unknown, previous studies 24, 25 have shown that RT has more adverse effects on older patients. Moreover, the radiation-induced aging-like pathology in cerebrocortical cells has been suggested 26 , including shrinkage of cortical thickness, activation of cell-cycle arrest pathway and inhibition of DNA double strand break repair.…”

Section: Discussionmentioning

confidence: 99%

A Radiation-Induced Hippocampal Vascular Injury Surrogate Marker Predicts Late Neurocognitive Dysfunction

Farjam¹,

Pramanik²,

Aryal³

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Purpose We aimed to develop a hippocampal vascular injury surrogate marker for early prediction of late neurocognitive dysfunction in patients receiving brain radiotherapy (RT). Methods and Materials 27 patients (17 males and 10 females, age 31–80 years) were enrolled in an IRB-approved prospective longitudinal study. Patients were diagnosed with a low-grade glioma or benign tumor and treated by 3-D conformal or intensity-modulated RT with a median dose of 54 Gy (50.4–59.4 Gy in 1.8-Gy fractions). Six dynamic-contrast enhanced MRI scans were performed from pre-RT to 18-month post-RT, and quantified for vascular parameters related to blood-brain barrier permeability, Ktrans, and the fraction of blood plasma volume, Vp. The temporal changes in the means of hippocampal Ktrans and Vp after starting RT were modeled by integrating the dose effects with age, sex, hippocampal laterality and presence of tumor/edema near a hippocampus. Finally, the early vascular dose-response in hippocampi was correlated with neurocognitive dysfunction 6 and 18-months post-RT. Results The Ktrans mean increased significantly from pre-RT to 1-month post-RT (p<0.0004), which significantly depended on sex (p<0.0007) and age (p<0.00004), with the dose-response more pronounced in older females. Also, the vascular dose-response in the left hippocampus of females correlated significantly with changes in memory function at 6 (r = −0.95, p<0.0006) and 18-months (r = −0.88, p<0.02) post-RT. Conclusions The early hippocampal vascular dose-response could be a predictor of late neurocognitive dysfunction. A personalized hippocampus sparing strategy may be considered in the future.

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Section: Discussionmentioning

confidence: 99%

A Radiation-Induced Hippocampal Vascular Injury Surrogate Marker Predicts Late Neurocognitive Dysfunction

Farjam¹,

Pramanik²,

Aryal³

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…After surgery, the standard treatment of gliomas includes chemotherapy combined with or without radiotherapy after the radical resection. Supportive care and treatment with corticosteroids and antiepileptics (AEs) play an important role in elderly patients [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Malignant Gliomas in Elderly Patients: A Concise Overview of the Literature

Farina

Lombardi

Bergo

et al. 2014

BioMed Research International

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Gliomas are the most frequent primary brain tumors and the incidence data has increased in the elderly population. Unfortunately, prospective studies on this population are few and so the right treatment is unknown. In the elderly patients no standard treatment has been established and therefore the optimal treatment should be individualized. We performed a review analyzing the prognostic and predictive factors, the clinical studies, and the correct management of this population.

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“…Hence, the better outcome in radical patients may be related to the selection of better prognosis patients. Moving forward, the involvement of a oncogeriatrican and standardized evaluation tools should also be incorporated into MDT to help guide treatment decisions …”

Section: Discussionmentioning

confidence: 99%

“…Moving forward, the involvement of a oncogeriatrican and standardized evaluation tools should also be incorporated into MDT to help guide treatment decisions. 22,23 Quality of life, which is especially important in GBM, was not always available from the notes and hence not evaluated in this study. Neurotoxicity and side effects of RT were not evaluated.…”

Section: T a B L E 5 Cox Regression Analysis On Radical Cohort Of Pat...mentioning

confidence: 99%

Glioblastoma Multiforme in the over 70's: “To treat or not to treat with radiotherapy?”

Glynn¹,

Rangaswamy²,

O’Shea³

et al. 2019

Cancer Medicine

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Background The incidence of Glioblastoma Multiforme (GBM) is increasing among the older population and is associated with poor prognosis. Management guidelines are lacking in this group. The purpose of this study was to analyze survival data and determine predictors of survival in patients aged ≥70 years treated with radiotherapy (RT) and/or Temozolomide. Materials and Methods A retrospective analysis of all GBM patients treated at our institution between January 2011 and January 2017 was carried out. Results One‐hundred and four patients were eligible. Median age was 73.8 years (70‐87). Thirty‐three patients received radical RT and 71 palliative RT. Overall median survival (MS) was 6 months. The MS was 10.6 months for radical patients and 4.9 months for palliative patients ( P < 0.0005). The MS was 6.9 months in patients aged 70‐75 years and 5.2 months in those aged 76‐80 years ( P = 0.004). The debulked group had a statistically significantly longer survival (8.0 months) than the biopsy only group (4.9 months). Biopsy only (hazard ratio [HR] 2.4), ECOG performance status 3 vs 0 (HR 6.4), and increasing age (HR 1.06) were associated with statistically significant shorter survival after adjustment for the effects of concurrent chemo, delay in starting RT, and RT dose. Conclusion The MS for radical patients was favorable and approaching current literature for the under 70 age group. Radical treatment should be considered for good performance patients aged 70‐75 years. Increasing age was associated with shorter MS in patients aged ≥76 years. Debulking and good performance status were associated with improved survival.

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High-grade glioma in elderly patients: can the oncogeriatrician help?

Cited by 4 publications

References 66 publications

A Radiation-Induced Hippocampal Vascular Injury Surrogate Marker Predicts Late Neurocognitive Dysfunction

A Radiation-Induced Hippocampal Vascular Injury Surrogate Marker Predicts Late Neurocognitive Dysfunction

Treatment of Malignant Gliomas in Elderly Patients: A Concise Overview of the Literature

Glioblastoma Multiforme in the over 70's: “To treat or not to treat with radiotherapy?”

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