Glioblastoma in the oldest old: clinical characteristics, therapy and outcome in patients aged 80 years and older

IF 2.4 Q2 CLINICAL NEUROLOGY
Christina Stadler, Dorothee Gramatzki, Emilie Le Rhun, Andreas F Hottinger, Thomas Hundsberger, Ulrich Roelcke, Heinz Läubli, Silvia Hofer, Katharina Seystahl, Hans-Georg Wirsching, Michael Weller, Patrick Roth
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Abstract

Abstract Background Incidence rates of glioblastoma in very old patients are rising. The standard of care for this cohort is only partially defined and survival remains poor. The aims of this study were to reveal current practice of tumor-specific therapy and supportive care, and to identify predictors for survival in this cohort. Methods Patients aged 80 years or older at the time of glioblastoma diagnosis were retrospectively identified in six clinical centers in Switzerland and France. Demographics, clinical parameters and survival outcomes were annotated from patient charts. Cox proportional hazards modeling was performed to identify parameters associated with survival. Results Of 107 patients, 45 were diagnosed by biopsy, 30 underwent subtotal resection and 25 had gross total resection. In 7 patients, the extent of resection was not specified. Post-operatively, 34 patients did not receive further tumor-specific treatment. Twelve patients received radiotherapy with concomitant temozolomide, but only 2 patients had maintenance temozolomide therapy. Fourteen patients received temozolomide alone, 35 patients radiotherapy alone, one patient received bevacizumab and one took part in a clinical trial. Median progression-free survival (PFS) was 3.3 months and median overall survival (OS) was 4.2 months. Among patients who received any postoperative treatment, median PFS was 3.9 months and median OS was 7.2 months. Karnofsky performance status (KPS) ≥ 70%, gross total resection and combination therapy were associated with better outcome. The median time spent hospitalized was 30 days, accounting for 23% of the median OS. End of life care was mostly provided by nursing homes (n = 20; 32%) and palliative care wards (n = 16; 26%). Conclusions In this cohort of very old patients diagnosed with glioblastoma, a large proportion was treated with best supportive care. Treatment beyond surgery and, in particular, combined modality treatment were associated with longer OS and may be considered for selected patients even at higher ages.
老年胶质母细胞瘤:80岁及以上患者的临床特征、治疗和预后
背景:胶质母细胞瘤在高龄患者中的发病率正在上升。该队列的护理标准仅部分确定,生存率仍然很低。本研究的目的是揭示当前肿瘤特异性治疗和支持性护理的实践,并确定该队列中生存的预测因素。方法回顾性分析瑞士和法国6个临床中心诊断为胶质母细胞瘤时年龄在80岁及以上的患者。人口统计学、临床参数和生存结果从患者图表中标注。采用Cox比例风险模型来确定与生存率相关的参数。结果107例患者中,活检确诊45例,次全切除30例,大体全切除25例。7例患者未明确切除范围。术后34例患者未接受进一步肿瘤特异性治疗。12例患者接受放疗联合替莫唑胺治疗,仅有2例患者接受替莫唑胺维持治疗。14例患者单独接受替莫唑胺治疗,35例患者单独接受放疗,1例患者接受贝伐单抗治疗,1例患者参加临床试验。中位无进展生存期(PFS)为3.3个月,中位总生存期(OS)为4.2个月。在接受任何术后治疗的患者中,中位PFS为3.9个月,中位OS为7.2个月。Karnofsky性能状态(KPS)≥70%,大体全切除和联合治疗的预后较好。中位住院时间为30天,占中位总生存期的23%。临终关怀主要由养老院提供(n = 20;32%)和姑息治疗病房(n = 16;26%)。结论:在这个诊断为胶质母细胞瘤的高龄患者队列中,很大一部分患者接受了最佳支持治疗。手术以外的治疗,特别是联合治疗与更长的生存期相关,甚至可以考虑在更高年龄的特定患者中使用。
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来源期刊
Neuro-oncology practice
Neuro-oncology practice CLINICAL NEUROLOGY-
CiteScore
5.30
自引率
11.10%
发文量
92
期刊介绍: Neuro-Oncology Practice focuses on the clinical aspects of the subspecialty for practicing clinicians and healthcare specialists from a variety of disciplines including physicians, nurses, physical/occupational therapists, neuropsychologists, and palliative care specialists, who have focused their careers on clinical patient care and who want to apply the latest treatment advances to their practice. These include: Applying new trial results to improve standards of patient care Translating scientific advances such as tumor molecular profiling and advanced imaging into clinical treatment decision making and personalized brain tumor therapies Raising awareness of basic, translational and clinical research in areas of symptom management, survivorship, neurocognitive function, end of life issues and caregiving
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