Recurrent glioblastomas in the elderly after maximal first-line treatment: does preserved overall condition warrant a maximal second-line treatment?

A growing literature supports maximal safe resection followed by standard combined chemoradiotherapy (i.e. maximal first-line therapy) for selected elderly glioblastoma patients. To assess the prognostic factors from recurrence in elderly glioblastoma patients treated by maximal safe resection follo...

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Veröffentlicht in:Journal of Neuro-Oncology Jg. 135; H. 2; S. 285 - 297
Hauptverfasser: Zanello, Marc, Roux, Alexandre, Ursu, Renata, Peeters, Sophie, Bauchet, Luc, Noel, Georges, Guyotat, Jacques, Le Reste, Pierre-Jean, Faillot, Thierry, Litre, Fabien, Desse, Nicolas, Emery, Evelyne, Petit, Antoine, Peltier, Johann, Voirin, Jimmy, Caire, François, Barat, Jean-Luc, Vignes, Jean-Rodolphe, Menei, Philippe, Langlois, Olivier, Dezamis, Edouard, Carpentier, Antoine, Dam Hieu, Phong, Metellus, Philippe, Pallud, Johan
Format: Journal Article
Sprache:Englisch
Veröffentlicht: New York Springer Science and Business Media LLC 01.11.2017
Springer US
Springer Nature B.V
Springer Verlag
Schlagworte:
[INFO.INFO-TI]Computer Science [cs]/Image Processing [eess.IV]
Age Factors
Aged
Aged, 80 and over
Angiogenesis
Bevacizumab
Brain Neoplasms
Brain Neoplasms - therapy
Chemoradiotherapy
Chemotherapy
Clinical Study
Combined Modality Therapy
Computer Science
Female
Follow-Up Studies
Geriatrics
Glioblastoma
Glioblastoma - therapy
Humans
Image Processing
Karnofsky Performance Status
Male
Medical prognosis
Medicine
Medicine & Public Health
Middle Aged
Monoclonal antibodies
Multivariate Analysis
Neoplasm Recurrence, Local
Neoplasm Recurrence, Local - therapy
Neurology
Oncology
Prognosis
Retrospective Studies
Surgery
Survival
Survival Analysis
Targeted cancer therapy
Temozolomide
Recurrence
Aged patients
Geriatric assessment
Karnofsky performance status
Glioblastoma
ISSN:0167-594X, 1573-7373, 1573-7373
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Zusammenfassung:A growing literature supports maximal safe resection followed by standard combined chemoradiotherapy (i.e. maximal first-line therapy) for selected elderly glioblastoma patients. To assess the prognostic factors from recurrence in elderly glioblastoma patients treated by maximal safe resection followed by standard combined chemoradiotherapy as first-line therapy. Multicentric retrospective analysis comparing the prognosis and optimal oncological management of recurrent glioblastomas between 660 adult patients aged of < 70 years (standard group) and 117 patients aged of ≥70 years (elderly group) harboring a supratentorial glioblastoma treated by maximal first-line therapy. From recurrence, both groups did not significantly differ regarding Karnofsky performance status (KPS) (p = 0.482). Oncological treatments from recurrence significantly differed: patients of the elderly group received less frequently oncological treatment from recurrence (p < 0.001), including surgical resection (p < 0.001), Bevacizumab therapy (p < 0.001), and second line chemotherapy other than Temozolomide (p < 0.001). In multivariate analysis, Age ≥70 years was not an independent predictor of overall survival from recurrence (p = 0.602), RTOG-RPA classes 5–6 (p = 0.050) and KPS at recurrence <70 (p < 0.001), available in all cases, were independent significant predictors of shorter overall survival from recurrence. Initial removal of ≥ 90% of enhancing tumor (p = 0.004), initial completion of the standard combined chemoradiotherapy (p = 0.007), oncological treatment from recurrence (p < 0.001), and particularly surgical resection (p < 0.001), Temozolomide (p = 0.046), and Bevacizumab therapy (p = 0.041) were all significant independent predictors of longer overall survival from recurrence. Elderly patients had substandard care from recurrence whereas age did not impact overall survival from recurrence contrary to KPS at recurrence <70. Treatment options from recurrence should include repeat surgery, second line chemotherapy and anti-angiogenic agents.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:0167-594X
1573-7373
1573-7373
DOI:10.1007/s11060-017-2573-y