title: Concomitant and adjuvant temozolomide of newly diagnosed glioblastoma in elderly patients.
abstract: OBJECTIVE
  The effect of concomitant and adjuvant temozolomide in glioblastoma patients above the age of 65 years lacks evidence. However, after combined treatment became standard at our center all patients were considered for combined therapy. We retrospectively analyzed the effect of temozolomide focused on elderly patients.
  
  
  METHODS
  293 patients with newly diagnosed glioblastoma treated single-centered between 1998 and 2010, by radiation alone or concomitant and adjuvant radiochemotherapy, were included. Treatment groups were analyzed by multi- and univariate analysis. Matched pairs for age, by a 5-year-caliper, extent of resection and general state was generated for all patients and elderly subgroups.
  
  
  RESULTS
  103 patients received radiation only and 190 combined treatment. Multivariate and matched pair analysis revealed a benefit due to combined temozolomide (HR 1.895 and 1.752, respectively). For patients older than 65 years median survival was 3.6 (95% CI 3.2-4.7) and 8.7 months (6.3-11.8) for radiotherapy only and combined treatment (HR 3.097, p<0.0001, n=90). Over the age of 70 and 75 years median survival was 3.2 (2.3-4.2) vs. 7.5 (5.1-10.9, HR 4.453, p<0.0001, n=62) and 3.2 (1.4-3.9) vs. 9.2 months (4.7-13.5; HR 9.037, p<0.0001, n=24), respectively. In 8/56 (14%) patients over the age of 70 years temozolomide was terminated due to toxicity.
  
  
  CONCLUSIONS
  Retrospective matched pair analysis gives class 2b evidence for prolonged survival due to concomitant and adjuvant temozolomide in elderly glioblastoma patients. Until prospective data for combined radiochemotherapy in elderly patients will be available concomitant and adjuvant temozolomide therapy should not be withheld.
authors.affiliation: Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Behm
authors.forename: Antonia
authors.initials: A
authors.lastname: Horowski
authors.forename: Simon
authors.initials: S
authors.lastname: Schneider
authors.forename: Hans Christoph
authors.initials: HC
authors.lastname: Bock
authors.forename: Dorothee
authors.initials: D
authors.lastname: Mielke
authors.forename: Veit
authors.initials: V
authors.lastname: Rohde
authors.forename: Florian
authors.initials: F
authors.lastname: Stockhammer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000628:therapy; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D016019:Survival Analysis; D000077204:Temozolomide; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Elderly; Glioblastoma; Matched pairs; Radiochemotherapy