International Atomic Energy Agency Randomized Phase III Study of Radiation Therapy in Elderly and/or Frail Patients With Newly Diagnosed Glioblastoma Multiforme

Roa, Wilson; Kępka, Lucyna; Kumar, Narendra; Sinaika, V.; Matiello, Juliana; Lomidze, Darejan; Hentati, Dalenda; Castro, Douglas Guedes de; Dyttus-Cebulok, Katarzyna; Drodge, Suzanne; Ghosh, Sunita; Jeremić, Branislav; Rosenblatt, Eduardo; Fidarova, Elena

doi:10.1200/jco.2015.62.6606

Cited by 275 publications

(187 citation statements)

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“…As a result, alternative treatment regimens have been proposed for this subgroup of patients. [24][25][26][27] . However, we find that CRT remained superior to RT alone when adjusting for age differences on multivariable analysis.…”

Section: Discussionmentioning

confidence: 99%

Concurrent chemoradiotherapy versus radiotherapy alone for “biopsy‐only” glioblastoma multiforme

Kole

Park

Yeboa

et al. 2016

Cancer

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BACKGROUND Combined temozolomide and radiotherapy (RT) is the standard postoperative therapy for glioblastoma multiforme (GBM). However, the clearest benefit of concurrent chemoradiotherapy (CRT) observed in clinical trials has been among patients who undergo surgical resection. Whether the improved survival with CRT extends to patients who undergo “biopsy only” is less certain. The authors compared overall survival (OS) in a national cohort of patients with GBM who underwent biopsy and received either RT alone or CRT during the temozolomide era. METHODS The US National Cancer Data Base was used to identify patients with histologically confirmed, biopsy‐only GBM who received either RT alone or CRT from 2006 through 2011. Demographic and clinicopathologic predictors of treatment were analyzed using the chi‐square test, the t test, and multivariable logistic regression. OS was evaluated using the log‐rank test, multivariable Cox proportional hazard regression, and propensity score‐matched analysis. RESULTS In total, 1479 patients with biopsy‐only GBM were included, among whom 154 (10.4%) received RT alone and 1325 (89.6%) received CRT. The median age at diagnosis was 61 years. CRT was associated with a significant OS benefit compared with RT alone (median, 9.2 vs 5.6 months; hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.54‐0.76; P < .001). CRT was independently associated with improved OS compared with RT alone on multivariable analysis (HR, 0.71; 95% CI, 0.60‐0.85; P < .001). A significant OS benefit for CRT persisted in a propensity score‐matched analysis (HR, 0.72; 95% CI, 0.56‐0.93; P = .009). CONCLUSIONS The current data suggest that CRT significantly improves OS in patients with GBM who undergo biopsy only compared with RT alone and should remain the standard of care for patients who can tolerate therapy. Cancer 2016;122:2364–2370. © 2016 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Concurrent chemoradiotherapy versus radiotherapy alone for “biopsy‐only” glioblastoma multiforme

Kole

Park

Yeboa

et al. 2016

Cancer

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“…Many elderly or frail patients are unable to tolerate combined chemoradiotherapy, and toxicities-including severe fatigue, myelosuppression, and infections-are common 9 . As a result, investigators have been led to explore alternative treatment strategies in older gbm patients, including hypofractionated radiotherapy 10,11 and temozolomide monotherapy 12 . Those studies are beginning to address the overall lack of data with respect to the optimal adjuvant therapy in elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Treatment and Outcomes for Glioblastoma in Elderly Compared with Non-elderly Patients: A Population-Based Study

Norman

Laing

2017

Current Oncology

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Purpose Elderly patients make up a large percentage of the individuals newly diagnosed with glioblastoma (gbm), but they face particular challenges in tolerating standard therapy, and compared with younger patients, they experience significantly shorter survival. We set out to compare clinical characteristics, treatment patterns, and outcomes in a non-elderly group (<65 years) and an elderly group (≥65 years) of patients diagnosed with gbm.Methods This retrospective population-based study used a province-wide cancer registry to identify patients with a new diagnosis of gbm within a 6-year period (2006)(2007)(2008)(2009)(2010)(2011)(2012). Of the 138 patients identified, 56 (40.6%) were 65 years of age or older. Demographic characteristics, treatment patterns, and overall survival (os) in the elderly and non-elderly groups were compared. Predictors of os were determined using multivariate analysis.Results Elderly patients were more likely to present with a poor performance status (Eastern Cooperative Oncology Group ≥ 2), to undergo biopsy without resection, and to receive whole-brain or hypofractionated radiotherapy. Compared with non-elderly patients, the elderly patients were less likely to receive adjuvant temozolomide. Survival time was significantly shorter in the elderly than in the non-elderly patients (7.2 months vs. 11.2 months). In multivariate analysis, surgical resection, hypofractionated radiotherapy (compared with whole-brain or conventional radiotherapy), and chemotherapy were predictive of os in older patients. Among elderly patients receiving radiation, survival was improved with the use of combined therapy compared with the use of radiation only (11.3 months vs. 4.6 months). ConclusionsOverall survival was shorter for elderly patients with gbm than for non-elderly patients; the elderly patients were also less likely to receive intensive surgical or adjuvant therapy. Our population-based analysis demonstrated improved os with surgical resection, hypofractionated radiotherapy, and temozolomide, and supports the results of recent clinical trials demonstrating a benefit for combination chemoradiotherapy in older patients.

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“…Diffuse large B-cell lymphoma has been under-treated in the elderly, because of toxicity concerns 23 . As in younger patients, the overall and progression-free survival of elderly patients is improved by the R-CHOP regimen.…”

Section: De-escalation Options For Elderly Patientsmentioning

confidence: 99%

Advances in caring for the older cancer patient: a report from the 2015 conference of the International Society of Geriatric Oncology

Stepney¹

2016

Cancer Biology &Amp; Medicine

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A paradox in cancer research is that the majority of patients enrolled in clinical trials are relatively young and fit while typical patients in daily practice are elderly and have comorbidities and impaired organ function. Given these differences, many major studies provide an imperfect guide to optimizing the treatment of the majority of patients. Since cancer incidence is highly correlated with age, and since the world's population is rapidly ageing, this problem can only increase. For this reason, oncologists and geriatricians need to collaborate in developing tools to systematically assess the health status of elderly patients and their fitness to receive cancer therapies of various intensity. Tailoring anti-cancer treatments and supportive care to individual needs should be seen as part of the move towards personalized medicine. Achieving this goal is as much of a challenge to developing and middle-income countries as it is to western nations. The 2015 annual conference of the International Society of Geriatric Oncology (SIOG) held in Prague, Czech Republic, November 2015 and had a global focus on advancing the science of geriatric oncology and supportive care. Central to this approach is the systematic assessment of life expectancy, independent functioning, and the physical and psychological health of older cancer patients. The assumption behind comprehensive geriatric assessment is that elderly cancer patients have complex needs. The implication is that effective intervention will require a multidisciplinary team. Examples of effective geriatric assessment, multidisciplinary working and supportive care were presented at the SIOG conference.

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International Atomic Energy Agency Randomized Phase III Study of Radiation Therapy in Elderly and/or Frail Patients With Newly Diagnosed Glioblastoma Multiforme

Cited by 275 publications

References 24 publications

Concurrent chemoradiotherapy versus radiotherapy alone for “biopsy‐only” glioblastoma multiforme

Concurrent chemoradiotherapy versus radiotherapy alone for “biopsy‐only” glioblastoma multiforme

Treatment and Outcomes for Glioblastoma in Elderly Compared with Non-elderly Patients: A Population-Based Study

Advances in caring for the older cancer patient: a report from the 2015 conference of the International Society of Geriatric Oncology

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