Incidence, risk factors, and reasons for hospitalization among glioblastoma patients receiving chemoradiation

Rahman, Rifaquat; Catalano, Paul J.; Reardon, David A.; Norden, Andrew D.; Wen, Patrick Y.; Lee, Eudocia Q.; Nayak, Lakshmi; Beroukhim, Rameen; Dunn, Ian F.; Golby, Alexandra J.; Johnson, Mark D.; Chiocca, E. Antonio; Claus, Elizabeth B.; Alexander, Brian M.; Arvold, Nils D.

doi:10.1007/s11060-015-1820-3

Cited by 14 publications

(14 citation statements)

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“…Around 60% of patients were concerned by posttreatment adverse neurological events, while around half of them had no visible progression. The occurrence of such events were correlated with lower OS as already described in the literature [9]. The presence of neurological disability at baseline was associated with neither worsened OS nor higher occurrence of post-treatment neurological events.…”

Section: Discussionsupporting

confidence: 74%

“…ii) neurological symptoms (following progression or treatment toxicities) may have dramatic consequences on independence and/or quality of life for such a frail population [6] [7]; iii) the life expectancy is extremely poor but has increased in the last decade with the development of post-operative treatments [2]; iv) GBM-speci c geriatric scales of frailty are still lacking. Age and performance status (PS) >2 are common negative prognostic factors [8] [9]. MGMT (O6-methylguanine-DNA methyltransferase) DNA-repair gene silencing and its consequence on therapeutics have been investigated considerably [10] [11].…”

Section: Introductionmentioning

confidence: 99%

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Old Does Not Necessarily Mean Worse: Standard Stupp Regimen for Elderly Patients (≥ 70 years) with Newly Diagnosed Glioblastoma

Vaugier

Ah-Thiane

Aumont

et al. 2021

Preprint

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Introduction Glioblastoma (GBM) is frequent in elderly patients, but their frailty provokes debate regarding optimal treatment in general, and the standard Stupp regimen in particular, although this is the mainstay for younger (<65 years) patients. Methods All patients with newly diagnosed GBM and age ≥ 70 who were referred to our institution for Stupp treatment were reviewed from 2004 to 2018. MGMT status was not available for treatment decision. The primary endpoint was overall survival (OS). Secondary outcomes were relapse-free survival (RFS), early (≤ 1 month after RCT) adverse neurological events (symptoms of intracranial hypertension and/or use of corticosteroids and/or hospitalization) and temozolomide hematologic toxicity assessed by CTCAE v5. Results 128 patients were included. The median age was 74.1 (IQR: 72-77). 15% of patients were ≥80 years. 62.5% and 37.5% of patients fulfilled the criteria for RPA class I-II and III-IV, respectively. 81% of patients received the entire RCT and 28% completed the maintenance temozolomide. With median follow-up of 11.7 months (IQR: 6.5-17.5), median OS was 11.7 months (CI95%: 10-13 months). Median RFS was 9.5 months (CI95%: 9-10.5 months). 60% of patients had early adverse neurological events, of whom 44% had progression and 8% experienced grade ≥3 hematologic adverse events. RPA class III-IV and occurrence of neurological events were associated with lower OS rates, whereas post-operative neurological disabilities were not. Age ≥80 was not associated with worsened outcomes. Conclusions Stupp radiochemotherapy was feasible and effective for “real-life” elderly patients diagnosed with glioblastoma, even in the case of post-operative neurological disabilities.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Old Does Not Necessarily Mean Worse: Standard Stupp Regimen for Elderly Patients (≥ 70 years) with Newly Diagnosed Glioblastoma

Vaugier

Ah-Thiane

Aumont

et al. 2021

Preprint

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“…TLC cutoff of less than 0.2k/μL and the 2-month time point were chosen based on previous studies reporting these measures of TRL as predictors of worse survival. G4 lymphopenia [7][8][9][10] and persistent lymphopenia at 2 months after initiating CRT [13][14][15][16][17] have been correlated with poorer survival in other solid malignancies. Characteristics of patients with versus without G4 TRL at 2 months were compared using the Kruskal-Wallis test for continuous variables and Fisher's exact test statistics for categorical variables.…”

Section: Discussionmentioning

confidence: 99%

Chemoradiation-Related Lymphopenia and Its Association with Survival in Patients with Squamous Cell Carcinoma of the Anal Canal

et al. 2020

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Background. Although treatment-related lymphopenia (TRL) is common and associated with poorer survival in multiple solid malignancies, few data exist for anal cancer. We evaluated TRL and its association with survival in patients with anal cancer treated with chemoradiation (CRT). Materials and Methods. A retrospective analysis of 140 patients with nonmetastatic anal squamous cell carcinoma (SCC) treated with definitive CRT was performed. Total lymphocyte counts (TLC) at baseline and monthly intervals up to 12 months after initiating CRT were analyzed. Multivariable Cox regression analysis was performed to evaluate the association between overall survival (OS) and TRL, dichotomized by grade (G)4 TRL (<0.2k/μL) 2 months after initiating CRT. Kaplan-Meier and log-rank tests were used to compare OS between patients with versus without G4 TRL. Results. Median time of follow-up was 55 months. Prior to CRT, 95% of patients had a normal TLC (>1k/μL). Two months after initiating CRT, there was a median of 71% reduction in TLC from baseline and 84% of patients had TRL: 11% G1, 31% G2, 34% G3, and 8% G4. On multivariable Cox model, G4 TRL at two months was associated with a 3.7-fold increased risk of death. On log-rank test, the 5-year OS rate was 32% in the cohort with G4 TRL versus 86% in the cohort without G4 TRL. Conclusion. TRL is common and may be another prognostic marker of OS in anal cancer patients treated with CRT. The association between TRL and OS suggests an important role of the host immunity in anal cancer outcomes. The Oncologist 2020;25:1-8 Implications for Practice: This is the first detailed report demonstrating that standard chemoradiation (CRT) commonly results in treatment-related lymphopenia (TRL), which may be associated with a poorer overall survival (OS) in patients with anal squamous cell carcinoma. The association between TRL and worse OS observed in this study supports the importance of host immunity in survival among patients with anal cancer. These findings encourage larger, prospective studies to further investigate TRL, its predictors, and its relationship with survival outcomes. Furthermore, the results of this study support ongoing efforts of clinical trials to investigate the potential role of immunotherapy in anal cancer.

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“…7,9,[20][21][22] High glycemia and prolonged hospitalization also represent unfavorable prognostic factors. 23,24 In the EORTC-NCIC trial, the addition of temozolomide and the methylation of MGMT promoter are the two main factors that impact OS. In a study aiming to identify prognostic factors for survival in 333 patients with malignant gliomas included phase I and II clinical trials, 22 age, poor Karnofsky performance status, corticosteroid use, short PFS, tumor outside of the frontal lobe, and grade IV gliomas, which were associated with a shorter OS.…”

Section: Discussionmentioning

confidence: 99%

Age, Neurological Status MRC Scale, and Postoperative Morbidity are Prognostic Factors in Patients with Glioblastoma Treated by Chemoradiotherapy

Verlut

Mouillet

Magnin

et al. 2016

Clin Med Insights Oncol

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INTRODUCTIONTemozolomide and concomitant radiotherapy followed by temozolomide has been used as a standard therapy for the treatment of newly diagnosed glioblastoma multiform since 2005. A search for prognostic factors was conducted in patients with glioblastoma routinely treated by this strategy in our institution.METHODSThis retrospective study included all patients with histologically proven glioblastoma diagnosed between June 1, 2005, and January 1, 2012, in the Franche-Comté region and treated by radiotherapy (daily fractions of 2 Gy for a total of 60 Gy) combined with temozolomide at a dose of 75 mg/m2 per day, followed by six cycles of maintenance temozolomide (150–200 mg/m2, five consecutive days per month). The primary aim was to identify prognostic factors associated with overall survival (OS) in this cohort of patients.RESULTSOne hundred three patients were included in this study. The median age was 64 years. The median OS was 13.7 months (95% confidence interval, 12.5–15.9 months). In multivariate analysis, age over 65 years (hazard ratio [HR] = 1.88; P = 0.01), Medical Research Council (MRC) scale 3–4 (HR = 1.62; P = 0.038), and occurrence of postoperative complications (HR = 2.15; P = 0.028) were associated with unfavorable OS.CONCLUSIONSThis study identified three prognostic factors in patients with glioblastoma eligible to the standard chemotherapy and radiotherapy treatment. Age over 65 years, MRC scale 3–4, and occurrence of postoperative complications were associated with unfavorable OS. A simple clinical evaluation including these three factors enables to estimate the patient prognosis. MRC neurological scale could be a useful, quick, and simple measure to assess neurological status in glioblastoma patients.

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Incidence, risk factors, and reasons for hospitalization among glioblastoma patients receiving chemoradiation

Cited by 14 publications

References 57 publications

Old Does Not Necessarily Mean Worse: Standard Stupp Regimen for Elderly Patients (≥ 70 years) with Newly Diagnosed Glioblastoma

Old Does Not Necessarily Mean Worse: Standard Stupp Regimen for Elderly Patients (≥ 70 years) with Newly Diagnosed Glioblastoma

Chemoradiation-Related Lymphopenia and Its Association with Survival in Patients with Squamous Cell Carcinoma of the Anal Canal

Age, Neurological Status MRC Scale, and Postoperative Morbidity are Prognostic Factors in Patients with Glioblastoma Treated by Chemoradiotherapy

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