Radiotherapy for Glioblastoma in the Elderly

Keime-Guibert, Florence; Chinot, Olivier; Taillandier, Luc; Cartalat‐Carel, Stéphanie; Frénay, Marc; Kantor, G.; Guillamo, Jean-Sébastien; Jadaud, É.; Colin, Philippe; Bondiau, Pierre‐Yves; Meneï, Philippe; Loiseau, Hugues; Bernier, V.; Honnorat, Jérôme; Barrié, Maryline; Mokhtari, Karima; Mazeron, Jean‐Jacques; Bissery, Anne; Delattre, Jean‐Yves

doi:10.1056/nejmoa065901

Cited by 716 publications

(408 citation statements)

References 23 publications

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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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“…Promoter methylation of the O 6 -methylguanine-DNA methyltransferase (MGMT) gene was established as a predictive biomarker for benefit from TMZ in newly diagnosed glioblastoma [3]. For elderly patients, e.g., older than 65-70 years, the standard of care for newly diagnosed glioblastoma without MGMT promoter methylation or unknown MGMT status is radiotherapy alone [4]. In contrast, elderly patients with glioblastoma with MGMT promoter methylation should receive TMZ without or with radiotherapy [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic options in recurrent glioblastoma—An update

Seystahl

Wick

Weller

2016

Critical Reviews in Oncology/Hematology

171

134

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“…Although a few trials since then have included older patients, 17,18 the focus those trials has been on the application of adjuvant therapy after nondefinitive, attempted or completed gross total resection of tumor. It has been demonstrated that gross total resection has a survival advantage compared with partial resection and certainly compared with biopsy alone.…”

Section: Interpretations In the Context Of The Literaturementioning

confidence: 99%

Short‐term outcomes of craniotomy for malignant brain tumors in the elderly

Seicean

Schiltz

et al. 2012

Cancer

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BACKGROUND. Disparity in resection rates for malignant brain tumors in elderly patients is partially attributed to a belief that advanced age is associated with an increased risk of postoperative morbidity and mortality. The objective of this study was to investigate the effect of advanced age (!75 years) on 30-day outcomes in patients with primary and metastatic brain tumors who underwent craniotomy for definitive resection of a malignant brain tumor. METHODS. The authors conducted prospective analyses of the American College of Surgeons' National Surgical Quality-Improvement Project (NSQIP) database from 2006 to 2010 of 970 patients aged !40 years who underwent craniotomy for definitive resection of neoplasm. Preoperative and intraoperative characteristics and 30-day outcomes were stratified by age. By using propensity scores, 134 patients (aged !75 years) were matched to 134 patients ages 40 to 74 years. Logistic regression was used to predict adverse postoperative outcomes. RESULTS. The median length of hospital stay was 5 days; the rate of minor and major complications were 5.9% and 13.1%, respectively; 5.7% of patients returned to the operating room; and 4.3% of patients died within 30 days. Advanced age did not increase the odds for poorer short-term outcomes. CONCLUSIONS. Advanced age did not increase the risk of poor outcomes after surgical resection of primary or metastatic intracranial tumors when analyses were controlled for other risk factors. These results suggest that age should not be used, in isolation, as an a priori factor to discourage pursuing craniotomy.

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Radiotherapy for Glioblastoma in the Elderly

Abstract: Radiotherapy results in a modest improvement in survival, without reducing the quality of life or cognition, in elderly patients with glioblastoma. (ClinicalTrials.gov number, NCT00430911 [ClinicalTrials.gov].).

Cited by 716 publications

References 23 publications

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

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

Therapeutic options in recurrent glioblastoma—An update

Short‐term outcomes of craniotomy for malignant brain tumors in the elderly

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