title: Which elderly newly diagnosed glioblastoma patients can benefit from radiotherapy and temozolomide? A PERNO prospective study.
abstract: The role of temozolomide concurrent with and adjuvant to radiotherapy (RT/TMZ) in elderly patients with glioblastoma (GBM) remains unclear. We evaluated the outcome of patients >70 years in the context of the Project of Emilia-Romagna Region in Neuro-Oncology (PERNO), the first Italian prospective observational population-based study in neuro-oncology. For this analysis the criteria for selecting patients enrolled in the PERNO study were: age >70 years; PS 0-3; histologically confirmed GBM; postoperative radiotherapy (RT) after surgery with or without concomitant temozolomide (TMZ) or postsurgical TMZ alone. Between January 2009 and December 2010, 76 GBM elderly patients were identified in the prospective PERNO study. Twenty-three patients did not receive any treatment after surgery, and 53 patients received postsurgical treatments (25 patients received RT alone and 28 patients RT/TMZ). Median survival was 11.1 months (95 % CI 8.8-13.5), adding temozolomide concomitant and adjuvant to radiotherapy it was 11.6 months (95 % CI 8.6-14.6), and 9.3 months (95 % CI 8.1-10.6) in patients treated with RT alone (P = 0.164). However, patients with MGMT methylated treated with RT/TMZ obtained a better survival (17.2 months, 95 % CI 11.5-22.9) (P = 0.042). No difference in terms of survival were observed if patients with MGMT unmethylated tumor received RT alone, or RT/TMZ or, in MGMT methylated tumor, if patients received radiotherapy alone. In elderly patients RT/TMZ represent a widely used approach but it is effective with methylated MGMT tumors only.
authors.affiliation: Department of Medical Oncology, Bellaria Hospital, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura 3, 40139, Bologna, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Franceschi
authors.affiliation: Department of Oncology, Hematology and Respiratory Diseases, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Depenni
authors.affiliation: Department of Medical Oncology, Bellaria Hospital, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura 3, 40139, Bologna, Italy.
authors.forename: Alexandro
authors.initials: A
authors.lastname: Paccapelo
authors.affiliation: Department of Neurosciences, Statistics and Informatics Unit, Azienda Ospedale-Università, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Ermani
authors.affiliation: Department of Oncology and Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) - IRCCS, Viale Ghirotti, 286, 47521, Cesena, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Faedi
authors.affiliation: Department of Neurosurgery, Bellaria Hospital, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Sturiale
authors.affiliation: Department of Medical Oncology, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Michiara
authors.affiliation: Department of Neurosurgery, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Servadei
authors.affiliation: Department of Neurosurgery, Ospedale S. Agostino-Estense, via Giardini 1355, 41126, Modena, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pavesi
authors.affiliation: Clinical Oncology Unit, St Anna University Hospital, Corso Giovecca 203, 44121, Ferrara, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Urbini
authors.affiliation: Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Pisanello
authors.affiliation: Department of Neuroradiology, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy.
authors.forename: Girolamo
authors.initials: G
authors.lastname: Crisi
authors.affiliation: Department of Neurosurgery, St Anna University Hospital, Corso Giovecca 203, 44121, Ferrara, Italy.
authors.forename: Michele A
authors.initials: MA
authors.lastname: Cavallo
authors.affiliation: Department of Oncology and Hematology, General Hospital, Via Randi 5, 48100, Ravenna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Dazzi
authors.affiliation: Department of Oncology and Hematology, Oncology Unit, Azienda Ospedaliera Guglielmo da Saliceto, Via Taverna 49, 29100, Piacenza, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Biasini
authors.affiliation: Department of Oncology, Hematology and Respiratory Diseases, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Bertolini
authors.affiliation: Medical Oncology Unit, Ramazzini Hospital, Via Molinari 2, 41012, Carpi, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Mucciarini
authors.affiliation: Department of Medical Oncology, Infermi Hospital, Via Settembrini 2, 47900, Rimini, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pasini
authors.affiliation: IRCCS Institute of Neurological Sciences, via Altura 3, 40139, Bologna, Italy.|Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Foscolo 7, 40123, Bologna, Italy.
authors.forename: Agostino
authors.initials: A
authors.lastname: Baruzzi
authors.affiliation: Department of Medical Oncology, Bellaria Hospital, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura 3, 40139, Bologna, Italy. alba.brandes@yahoo.it.
authors.forename: Alba A
authors.initials: AA
authors.lastname: Brandes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D019175:DNA Methylation; D015254:DNA Modification Methylases / Q000235:genetics; D045643:DNA Repair Enzymes / Q000235:genetics; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005909:Glioblastoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D011401:Promoter Regions, Genetic; D011446:Prospective Studies; D016019:Survival Analysis; D000077204:Temozolomide; D025521:Tumor Suppressor Proteins / Q000235:genetics
chemical_list: D018906:Antineoplastic Agents, Alkylating; D025521:Tumor Suppressor Proteins; D003606:Dacarbazine; D015254:DNA Modification Methylases; C515491:MGMT protein, human; D045643:DNA Repair Enzymes; D000077204:Temozolomide
keywords: Elderly; Glioblastoma; MGMT methylation; Radiotherapy; Temozolomide