title: Concurrent temozolomide and radiation, a reasonable option for elderly patients with glioblastoma multiforme?
abstract: OBJECTIVE
  There is no accepted standard of care for patients over age 70 with glioblastoma (GBM). We began this study to describe our results and toxicities in the over 70 population treated with concurrent temozolomide and radiation for GBM, and to describe our outcomes treating elderly patients with GBM regardless of therapy.
  
  
  METHODS
  We reviewed the records of all patients aged 70 or older who were diagnosed with glioblastoma since 2002 at the University of North Carolina to determine age at diagnosis, performance status, neurologic status, recursive partitioning analysis class, treatment received, and toxicity. Median survival was calculated according to the Kaplan-Meier method and compared by the Log-rank test.
  
  
  RESULTS
  Thirty-one patients were identified with a median age of 76 years and a median survival of 20.6 weeks. Thirteen patients received best supportive care, 4 patients were treated with radiation alone, and 14 with radiation and concurrent temozolomide. The median survival for each group was 8.4, 28.2, and 50.5 weeks, respectively. Grade 1/2 toxicity was seen in 20% of patients, whereas only 1 patient had grade 3 toxicity. Neurologic status (P = 0.0028), performance status (P = 0.0096), and recursive partitioning analysis class (P = 0.0033) retained their prognostic significance.
  
  
  CONCLUSIONS
  Concomitant daily temozolomide and radiation followed by adjuvant temozolomide is a tolerable and reasonable treatment option and has a good performance status for elderly patients diagnosed with glioblastoma.
authors.affiliation: Departments of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA. rkimple@unch.unc.edu
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Kimple
authors.forename: Sarah
authors.initials: S
authors.lastname: Grabowski
authors.forename: Michael
authors.initials: M
authors.lastname: Papez
authors.forename: Frances
authors.initials: F
authors.lastname: Collichio
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Ewend
authors.forename: David E
authors.initials: DE
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide