Table 3 Major studies regarding elderly glioblastoma patients
From: Radiotherapy plus temozolomide in elderly patients with glioblastoma: a “real-life” report
Major interest | Reference | Year | Design | Number of patients | Age | KPS | Treatment | Median survival in months (p) | Notes |
|---|---|---|---|---|---|---|---|---|---|
Surgery | Vuorien et al.[30] | 2003 | Prospective | 23 | ≥ 65 | > 60 | Biopsy + RT | 2.8 | Longer survival after resection while time to neurological deterioration did not differ. |
Resection + RT | 5.7 (< 0.05) | ||||||||
Radio-therapy | Roa et al.[6] | 2004 | Prospective | 100 | ≥ 60 | ≥ 50 | RT | 5.1 | Half overall treatment time for HFRT with no difference in survival. |
HFRT | 5.6 (ns) | ||||||||
Keime-Guibert et al. [5] | 2010 | Prospective | 81 | ≥ 70 | ≥ 70 | Supportive care | 3.9 | No negative effect of RT on quality of life. | |
RT | 6.7 (< 0.01) | ||||||||
Radio-therapy + TMZ | Minniti et al. [34] | 2009 | Prospective | 43 | ≥ 70 | ≥ 60 | HFRT + TMZ | 9.3 | Grade 3–4 hematologic toxicity occurred in 28% of patients. no negative effect on quality of life. |
Minniti et al. [33] | 2012 | Prospective | 71 | >70 | > 60 | HFRT + TMZ and TMZ | 12.4 | Grade 3–4 hematologic toxicity occurred in15% of patients. | |
Minniti et al. [31] | 2015 | Retrospecitve | 127 | ≥ 65 | ≥ 60 | RT + TMZ and TMZ | 12 | No difference in overall survival or progression free survival between standard RT and HFRT | |
HFRT + TMZ and TMZ | 12.5 (ns) | ||||||||
Lombardi et al. [11] | 2015 | Retrospecitve | 237 | ≥65 | ECOG PS 0–2 | HFRT + TMZ | 13.8 | Potential advantage of standard RT over HFRT for “moderate” elderly patients with good clinical status and extensive surgery | |
RT + TMZ | 19.4 (p = 0.02) | ||||||||
Perry et al.[14] | 2017 | Prospective | 562 | ≥65 | ECOG PS 0–2 | HFRT | 7.6 | The addition of TMZ (concomitant and adjuvant) to HFRT resulted in longer overall survival than HFRT alone | |
HFRT + TMZ and TMZ | 9.3 (p < 0.001) | ||||||||
Present study | 2017 | Retrospective | 104 | ≥ 70 | ≥ 30 | HFRT | 3.9 (p < 0.05)* | Potential benefit of combining TMZ with RT in an unselected cohort, irrespective of MGMT promoter status. | |
HFRT + TMZ | 5.5 | ||||||||
RT + TMZ | 9.6 (ns)** | ||||||||
HFRT alone | Guedes de Castro et al. [32] | 2017 | Prospective | 61 | ≥ 65 | ≥ 50 | HFRT 40Gy in 15 fractions | 6.2 | HFRT of 25Gy in 5 fractions seemed acceptable especially for elderly patients with a poor performance status or contraindication to chemotherapy. |
HFRT 25Gy in 5 fractions | 9.1 | ||||||||
TMZ alone | Wick et al. [8] | 2012 | Prospective | 371 | > 65 | ≥ 60 | Dose-dense TMZ alone | 8.0 | MGMT methylation is a predictive marker of TMZ alone efficacy. |
RT | 9.6 (ns) | ||||||||
Malmström et al. [7] | 2012 | Prospective | 291 | ≥ 60 | OMS 0–2 | TMZ alone | 8 | No benefit of RT over HFRT. MGMT methylation is a predictive marker of TMZ alone efficacy. | |
HFRT | 7.5 | ||||||||
RT | 6 | ||||||||
Poor perfor-mance status | Gállego Pérez-Larraya et al. [35] | 2011 | Prospective | 70 | ≥ 70 | <70 | TMZ alone | 5.8 | KPS improvement in 30% of patients by 10 or more points. |
Reyes-Botero et al. [36] | 2013 | Prospective | 66 | ≥ 70 | <70 | TMZ + Bevacizumab | 5.5 | Lower safety of the combination of TMZ with bevacizumab, no survival benefit |