Role of irradiation for patients over 80 years old with glioblastoma: a retrospective cohort study.
To assess efficacy and safety of hypofractionated radiation therapy (HRT) in patients over 80 years old with newly diagnosed glioblastoma (GBM). Between June 2009 and September 2015, patients in this population with a recommendation for radiation therapy from a multidisciplinary tumor board, and a Karnofsky performance status (KPS) ≥60 as assessed by a radiation oncologist, who received HRT (40 Gy/15 fractions) ± concomitant and adjuvant temozolomide (TMZ) were retrospectively analyzed. A total of 21 patients fulfilled the criteria for eligibility. Median KPS was 80 (60-90). After a median follow-up of 5.8 months (IQR 3.7-13.1 months), median overall survival (OS) was 7.5 months (95 % CI 4.5-19.1) and the 1-year and 2-year OS were 39.5 % (95 % CI 21.9-71.2 %) and 6.6 % (95 % CI 1.0- 43.3 %), respectively. Median progression-free survival (PFS) was 5.8 months (95 % CI 3.9-7.7 months), 1-year and 2-year PFS were 15.2 % (95 % CI 4.4-52.4) and 0 %, respectively. Overall, 16 (76.2 %) patients presented a recurrence. Overall seven patients (33.3 %) needed to be hospitalized during treatment. On univariate analysis, hospitalization was the only variable that correlated with less favourable outcome in terms of both OS (12.2 months versus 3.8 months, p < 0.010) and PFS (5.8 months versus 3.4 months, p = 0.002). Our study suggests that HRT is feasible with acceptable tolerance among "very elderly" patients affected by GBM. Patients 80 and older should be considered for management based on RT.
Department of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy. stefano.bracci@yahoo.it.
Stefano
S
Bracci
Department of Neurology Mazarin, groupe hospitalier La Pitié Salpêtrière-Charles Foix (Assistance Publique-Hôpitaux de Paris), 47-83 Boulevard de l'hôpital, 75651, Paris cedex 13, France.
Florence
F
Laigle-Donadey
Department of Radiation Oncology, University of Florida, 2000 SW Archer Road, Gainesville, Fl, 32610, USA.
Kathryn
K
Hitchcock
Department of Neurology Mazarin, groupe hospitalier La Pitié Salpêtrière-Charles Foix (Assistance Publique-Hôpitaux de Paris), 47-83 Boulevard de l'hôpital, 75651, Paris cedex 13, France.
Alberto
A
Duran-Peña
Department of Neurosurgery, groupe hospitalier La Pitié Salpêtrière-Charles Foix (Assistance Publique-Hôpitaux de Paris), 47-83 Boulevard de l'hôpital, 75651, Paris cedex 13, France.
Soledad
S
Navarro
Department of Radiation Oncology, groupe hospitalier La Pitié Salpêtrière-Charles Foix (Assistance Publique-Hôpitaux de Paris), 47-83 Boulevard de l'hôpital, 75651, Paris cedex 13, France.
Antoine
A
Chevalier
Department of Radiation Oncology, groupe hospitalier La Pitié Salpêtrière-Charles Foix (Assistance Publique-Hôpitaux de Paris), 47-83 Boulevard de l'hôpital, 75651, Paris cedex 13, France.
Julian
J
Jacob
Department of Radiation Oncology, groupe hospitalier La Pitié Salpêtrière-Charles Foix (Assistance Publique-Hôpitaux de Paris), 47-83 Boulevard de l'hôpital, 75651, Paris cedex 13, France.
Idriss
I
Troussier
Department of Neurology Mazarin, groupe hospitalier La Pitié Salpêtrière-Charles Foix (Assistance Publique-Hôpitaux de Paris), 47-83 Boulevard de l'hôpital, 75651, Paris cedex 13, France.
Jean-Yves
JY
Delattre
Department of Radiation Oncology, groupe hospitalier La Pitié Salpêtrière-Charles Foix (Assistance Publique-Hôpitaux de Paris), 47-83 Boulevard de l'hôpital, 75651, Paris cedex 13, France.
Jean-Jacques
JJ
Mazeron
Department of Neurology Mazarin, groupe hospitalier La Pitié Salpêtrière-Charles Foix (Assistance Publique-Hôpitaux de Paris), 47-83 Boulevard de l'hôpital, 75651, Paris cedex 13, France.
Khê
K
Hoang-Xuan
Department of Radiation Oncology, groupe hospitalier La Pitié Salpêtrière-Charles Foix (Assistance Publique-Hôpitaux de Paris), 47-83 Boulevard de l'hôpital, 75651, Paris cedex 13, France.
Loïc
L
Feuvret
D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D015331:Cohort Studies; D016371:Cranial Irradiation / Q000379:methods*; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D000069473:Radiation Dose Hypofractionation; D016019:Survival Analysis; D000077204:Temozolomide; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
Elderly; Glioblastoma; Radiation therapy; Temozolomide