Radiation therapy for older adults with glioblastoma: radical treatment, palliative treatment, or no treatment at all?

Minniti, Giuseppe; Enrici, Riccardo Maurizi

doi:10.1007/s11060-014-1566-3

Cited by 9 publications

(5 citation statements)

References 41 publications

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“…The question is whether these patients should be treated with a comparably aggressive combined treatment, palliative radiotherapy plus supportive care, or with best supportive care (BSC) including corticosteroids alone. In 2007, a randomized trial compared BSC with vs. without 50 Gy of radiotherapy in patients ≥70 years of age with glioblastoma (WHO grade IV) or anaplastic astrocytoma (WHO grade III) (3,18,19). The trial was stopped after an interim analysis of 85 patients (81 with glioblastoma).…”

Section: Discussionmentioning

confidence: 99%

Palliative Radiotherapy of Primary Glioblastoma

Witteler

Schild

Rades

2021

In Vivo

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Section: Discussionmentioning

confidence: 99%

Palliative Radiotherapy of Primary Glioblastoma

Witteler

Schild

Rades

2021

In Vivo

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“…The alternative treatment for elderly GBM patients primarily includes hypofractionated RT (HRT), where larger fractions of radiation are administered over a shorter period of time compared with standard RT (6). In certain cases, concurrent TMZ has been added to HRT, based on the superior outcomes reported with the Stupp protocol (7,8), although it has not yet been established that combining HRT with concurrent TMZ is superior to HRT alone (9).…”

Section: Introductionmentioning

confidence: 99%

A Surveillance, Epidemiology and End Results-Medicare data analysis of elderly patients with glioblastoma multiforme: Treatment patterns, outcomes and cost

Burton

Ugiliweneza

Woo

et al. 2015

Molecular and Clinical Oncology

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Abstract. The Surveillance, Epidemiology and End Results (SEER) database was used to determine the treatment patterns, outcomes and cost of therapy in elderly patients with glioblastoma multiforme (GBM). The SEER-Medicare linked database was used to identify patients aged >66 years with GBM diagnosed between 1997 and 2009. The patients were stratified by initial treatment following diagnostic surgery (resection or biopsy) into 6 groups as follows: No treatment, standard radiation therapy (SRT) with and without concurrent temozolomide (TMZ), hypofractionated RT (HRT) with and without concurrent TMZ, or TMZ alone. The 3,759 patients identified had a median age of 74 years (range, 66-97 years). A total of ~48% of the patients received SRT without TMZ; ~10% received SRT with concurrent TMZ; ~29% received no treatment; ~10% received HRT without TMZ; ~1% received HRT with TMZ; and <1% received TMZ alone. Untreated patients had a median survival of 2 months (range, 0-89 months). Patients treated with SRT with and without concurrent TMZ had a median survival of 11 and 9 months, respectively (P=0.01). Patients treated with HRT with and without TMZ or TMZ alone had a median survivals of 3 months [adjusted hazard ratio (AHR)=0.48; 95% confidence interval (CI): 0.36-0.66], 4 months (AHR=0.55; 95% CI: 0.49-0.62) and 6 months (AHR=0.43; 95% CI: 0.29-0.62), respectively. The median post-surgery total treatment cost for patients receiving HRT with and without TMZ or TMZ alone was 63,915, 42,834 and 48,298 USD, respectively. Standard RT with concurrent TMZ was associated with improved survival, even in patients aged >75 years. HRT with and without concurrent TMZ and TMZ alone improved survival compared to the no treatment group. Therefore, in certain cases, HRT or TMZ alone may be more cost-effective, with similar survival outcomes. The various treatment options highlight the need for geriatric assessment tools to aid in therapeutic decision making.

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“…During the interpretation of the results of the present study, its limitations need to be considered that include the retrospective study design (risk of hidden biases) and the comparably small sample size. Moreover, the extent of resection was previously reported to be significantly associated with survival in patients with GBM (32,33). Since our previous study showed only a trend for such an association, this factor was not included in the present score (13).…”

Section: Discussionmentioning

confidence: 97%

A New Survival Score for Patients Receiving Radiotherapy for Newly Diagnosed Glioblastoma Multiforme

et al. 2021

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Background/Aim: In a previous study investigating radiotherapy for newly diagnosed glioblastoma multiforme (GBM), significant or almost significant associations with survival were found for performance status, upfront resection, O 6 -methylguanine-DNA methyl-transferase (MGMT) promoter methylation and unifocal GBM. This study aimed to create a survival score based on these factors. Patients and Methods: Most of the 81 patients included received resection of GBM followed by radiochemotherapy (59.4 Gy/33 or 60 Gy/30 fractions). The previously identified predictors of survival were re-evaluated. Factors significantly associated with survival were used for the score. Results: All factors were significantly associated with survival. For each factor, 0 points (less favorable survival) or 1 point (more favorable survival) were assigned and added for each patient. Three groups were designed, 0-1 (n=10), 2 (n=21) and 3-4 points (n=50); 12month survival rates were 0%, 38% and 78% (p<0.001). Conclusion: A new survival score was created for patients requiring radiotherapy for GBM that can improve treatment personalization.Gliomas are the most common primary tumors of the central nervous system (CNS) in adults (1, 2). The classification of the World Health Organization includes four grades (I to IV). Patients with grade IV gliomas (glioblastoma multiforme, GBM) have the worst survival prognoses (3). Since publication of the randomized trial of Stupp et al. in 2005, the standard treatment for GBM has changed and includes maximum possible neurosurgical resection followed by concurrent radiochemotherapy and maintenance chemotherapy (4). The dosefractionation regimen used in the Stupp trial (EORTC 26981/22981-NCIC CE3) consisted of 60 Gy in 30 fractions (2.0 Gy per fraction on five consecutive days per week) combined with administration of 75 mg/m 2 of temozolomide (TMZ) on seven days per week (4). Concurrent radiochemotherapy was followed by six cycles of TMZ alone (150-200 mg/m 2 on five consecutive days every four weeks). This regimen resulted in a median survival of 14.6 months, which was 2.5 months longer than resection plus radiotherapy without TMZ (4). However, such a multi-modality treatment can be difficult for patients. In 2004, a randomized trial compared longer-course radiotherapy with 60 Gy in 30 fractions over six weeks to a shorter-course program, namely 40 Gy in 15 fractions of 2.66 Gy over three weeks in elderly patients (5). Median survival and survival at 6 months after randomization were similar in both groups. In this case, "elderly" was defined as ≥60 years. During the last decades, the median age of patients with GBM has increased to 64 years. Thus, 40 Gy in 15 fractions could be a reasonable option for many patients with this aggressive disease, particularly for patients with short or intermediate survival prognoses (1). More recently, Roa et al. presented another randomized trial that compared 40 Gy in 15 fractions over three weeks to a very short course of radiotherapy, 25 Gy in 5 fractions of 5 Gy over ...

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Radiation therapy for older adults with glioblastoma: radical treatment, palliative treatment, or no treatment at all?

Cited by 9 publications

References 41 publications

Palliative Radiotherapy of Primary Glioblastoma

Palliative Radiotherapy of Primary Glioblastoma

A Surveillance, Epidemiology and End Results-Medicare data analysis of elderly patients with glioblastoma multiforme: Treatment patterns, outcomes and cost

A New Survival Score for Patients Receiving Radiotherapy for Newly Diagnosed Glioblastoma Multiforme

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