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Radiotherapy with and without temozolomide in elderly patients with glioblastoma

Strahlentherapie mit und ohne Temozolomid bei älteren Glioblastom-Patienten

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Abstract

Background and purpose

The optimal treatment for elderly patients (age ≥ 70 years) with glioblastoma (GBM) remains controversial. We conducted a retrospective analysis in 43 consecutive elderly patients with glioblastoma who either underwent radiotherapy (RT) or radiotherapy plus concomitant temozolomide (TMZ).

Patients and methods

A total of 43 patients (≥ 70 years of age, median age 75.8 years) with newly diagnosed glioblastoma and a Karnofsky performance status (KPS) ≥ 70 were treated with RT alone (median 60 Gy in 2 Gy single fractions) or RT plus TMZ at a dose of 75 mg/m2 per day. The two groups were well-balanced; univariate (log-rank test) and multivariate Cox proportional hazards analysis were used to identify relevant prognostic factors.

Results

The median overall survival (mOS) of the entire patient cohort was 264 days (8.8 months) and the median progression-free survival (PFS) was 192 days (6.4 months). The factors age, sex, previous surgery, KPS, and concomitant use of TMZ had no significant influence on OS/PFS; multivariate analysis was performed to obtain adjusted hazard ratios. TMZ use resulted in a trend toward poorer overall survival when applied concomitantly (314 days compared to 192 days within the TMZ group, p = 0.106). The subgroup analysis revealed that TMZ use resulted in significantly worse survival rates in patients with KPS70 (p = 0.027), but for patients with KPS80 this difference was not detectable.

Conclusion

TMZ should only be used carefully in elderly patients with unfavorable KPS. In this patient cohort, radiotherapy alone is a reasonable option. Standard RT plus concomitant TMZ may be an advantageous treatment option for elderly patients with newly diagnosed glioblastoma who present with good prognostic factors.

Zusammenfassung

Fragestellung

Die optimale Behandlungsstrategie für ältere Patienten (Alter  ≥ 70 Jahre) mit einem Glioblastom (GBM) bleibt kontrovers. Aus diesem Grund haben wir eine retrospektive Analyse mit 43 Patienten durchgeführt, die nach OP/Biopsie entweder eine Strahlenchemotherapie mit Temozolomid (TMZ) erhielten oder nur bestrahlt (RT) wurden.

Patienten und Methodik

43 Patienten  ≥ 70 Jahre (medianes Alter 75,8 Jahre) mit einem neu diagnostizierten Glioblastom und einem Karnofsky-Performance-Status (KPS)  ≥ 70 wurden entweder nur bestrahlt (median 60 Gy in 2-Gy-Einzeldosen) oder erhielten konkomitant Temozolomid 75 mg/m2 pro Tag während der Bestrahlungsserie. Beide Gruppen waren ausgeglichen; zudem wurden univariate und multivariate Analysen durchgeführt, um relevante prognostische Faktoren zu identifizieren.

Ergebnisse

Das mediane Gesamtüberleben der Patientenkohorte betrug 264 Tage (8,8 Monate) und das mediane progressionsfreie Überleben 192 Tage (6,4 Monate). Die Faktoren Alter, Geschlecht, vorausgegangene OP, KPS sowie die konkomitante Gabe von Temozolomid hatten keinen signifikanten Einfluss auf das Gesamt- oder progressionsfreie Überleben, was in der multivariaten Analyse nochmals bestätigt wurde. Die Verwendung von Temozolomid resultierte in einem Trend zu einem schlechteren Gesamtüberleben, wenn es konkomitant verabreicht wurde (192 Tage für Patienten mit Temozolomid verglichen mit 314 Tagen innerhalb der Gruppe der nur bestrahlten Patienten; p = 0,106). Die Subgruppenanalyse ergab, dass Temozolomid bei Patienten mit einem KPS von 70 zu schlechteren Ergebnissen führte als bei Patienten mit einem KPS von 80, bei denen dieser Unterschied nicht mehr beobachtet werden konnte.

Schlussfolgerung

Temozolomid sollte bei älteren Glioblastom-Patienten vorsichtig eingesetzt werden, insbesondere bei jenen, deren Allgemeinzustand reduziert ist. Bei diesen Patienten scheint auch eine alleinige Bestrahlung eine vernünftige Option zu sein. Die Strahlenchemotherapie sollte Patienten vorbehalten bleiben, die günstige prognostische Faktoren aufweisen.

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Authors’ contributions

MN performed the retrospective analysis, associated statistics, and wrote the manuscript. BS and SBS participated in the preparation and data acquisition of the manuscript. CB participated in the conception as well as the preparation of the manuscript. All authors read and approved the final manuscript.

Conflict of interest

The corresponding author declares that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Ludwig-Maximilian-University Munich, Marchioninistr. 15, 81377, Munich, Germany

    M. Niyazi, S.B. Schwarz & C. Belka M.D., Ph.D.

  2. Department of Neurosurgery, Ludwig-Maximilian-University Munich, Munich, Germany

    B. Suchorska

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  1. M. Niyazi
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  3. B. Suchorska
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  4. C. Belka M.D., Ph.D.
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Correspondence to C. Belka M.D., Ph.D..

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Niyazi, M., Schwarz, S., Suchorska, B. et al. Radiotherapy with and without temozolomide in elderly patients with glioblastoma. Strahlenther Onkol 188, 154–159 (2012). https://doi.org/10.1007/s00066-011-0026-7

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  • DOI: https://doi.org/10.1007/s00066-011-0026-7

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