Hypofractionated radiotherapy results of patients with malign glioma aged 60 and over

Abstract

Aim: The aim of this study is to examine the treatment results of 25 malign glioma patients, aged >60 who underwent hypofractionated radiotherapy, respectively. Material and Method: Total excision was applied to 14 of the patients, subtotal excision was applied to 5 and biopsy was applied only to 3. Three patients were evaluated as inoperable. Pathological diagnosis is compatible with glioblastoma in 22 patients, gliosarcoma in 2 patients and anaplastic astrocytoma in 1 patient. Hypofractionated radiotherapy was applied to all patients in the dose range 2.66-3.4 Gy x 10-15 fractions. Ten patients were treated concurrent temozolomide with radiotherapy and then 4-6 cures of adjuvant temozolomide. Only concurrent temozolomide treatment was applied to 3 patients, while only adjuvant temozolomide was applied to 4 patients. Results: The median age is 72 years. (min 60–max 86) . The rate of patients with comorbid disease is 44%. The median follow-up period of the patients is 5 months (min 1-max 22). 6-months, 1-year, 18-months overall survival were 47%, 20%, 10%, respectively. Median survival in patients aged >70 is 3 months and 8 months in patients <70 (p=0.025). Median survival is 10 months in patients receiving both concurrent and adjuvant temozolomide treatment, and median survival is 3 months (p=0.007) in patients who do not receive it. Conclusion: Overall survival is statistically better in patients under the age of 70 and patients receiving both concurrent and adjuvant temozolomide therapy with hypofractionated radiotherapy.

Keywords

• Malignant Glioma
• Hypofractionated Dose
• Chemotherapy
• Elderly

References

1. Arvold ND, Reardon D.Treatment options and outcomes for glioblastoma in the elderly patients. Clin Interv Aging 2014; 9: 357-67
2. Stupp R ME, Hegi WP. Mason et al. Effects of raditherapy with concomitant adjuvan temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009; 10: 459-66
3. Scoccianti S, Magrini SM, Ricardi U, et al. Patterns of care and survival in a retrospective analysis of 1059 patients with glioblastoma multiforme treated between 2002 and 2007: a multicenter study by the Central Nervous System Study Group of Airo( italian Association of Radiation Oncology). Neurosurgery 2010; 67: 446-58
4. Perry JR, Laperrier NO, Callaghan CJ, et al. Short–course Radiation plus temozolomide in elderly patients with glioblastoma. N Engl J Med 2017; 376,: 1027-37.
5. Glaser SM, Dohopolski MJ, Balasubramani GK, et al. Glioblastoma multiforme (GBM) in the elderly: initial treatment strategy and overall survival. J Neurooncol 2017; 134: 107-18.
6. Kim H, Leiby BE, Shi W, et al .Too little, too soon: short course radiotherapy in elderly patients with glioblastoma. J Clin Oncol 2016; 34: 2191-2.
7. Cao JQ, Fisher BJ, Bauman GS, et al. Hypofractioneted radiotherapy with or without concurrent temozolomide in elderly patients with glioblastoma multiforme a review of ten- years ingle instutitional experience. J Neurooncol 2012; 107: 395-405.
8. Nguyen LT, Touch S, Nehme–Schuster H, et al. Outcomes in newly diagnosed elderly glioblastoma patients after concomitant temozolomide administration and hypofractioneted radiotherapy. Cancers (Basel) 2013; 5: 1177-98.

9. Reyngold M, Lassman AB, Chan TA, et al. Abbreviated course of radiation therapy with concurrent temozolomide with high grade glioma in patients of advanced age or poor functional status.J. Neuro Oncol.2012; 110: 369-74.
10. Minniti G, Scaringi C, Gaetano L, et al. Standard (60 Gy) or short–course (40 Gy) irradiation plus concomitant and adjuvant temozolomide for elderly patients with glioblastoma: a propensity match analysis. Int J Radiat Oncol Biol Phys 2015; 1; 91: 109-15.
11. Malmstrom A, Gronberg BH, Marosi C, et al. Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised , phase 3 trial. Lancet Oncol 2012; 13: 916-26.
12. Muni R, Minniti G, Lanzetta G, et al. Short–term radiotherapy followed by adjuvant chemotherapy in poor-prognosis patients with glioblastoma.Tumori 2010; 96: 60-4.
13. Kole AJ, Park HS, Neboa DY, et al. Concurrent chemoradiotherapy versus radiotherapy alone for ‘biopsy-only’ glioblastoma multiforme. Cancer 2016; 122: 2364-70.
14. Laigle-Donadey F, Figarella-Branger D, Chinot O, et al. Upfront temozolomide in elderly patients with glioblastoma. J Neurooncol 2010; 99: 89-94.
15. Gallego Perez-Larraya J, Ducray F, Chinot O, et al. Temozolomide in elderly patients with newly diagnosed glioblastoma and poor performance status: an ANOCEF phase II TRIAL. J Clin Oncol 2011; 29: 3050-5.
16. Mak KS, Ankit A, Qureshi MM, et al. Hypofractionated short-course radiotherapy in elderly patients with glioblastoma multiforme: an analysis of the National Cancer Database: Cancer Med 2017; 6: 1192-200.
17. Oszvald A, Guresir E, Setzer M, et al. Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age. J Neurosurg 2012; 116: 357-64.
18. McGirt MJ, Chaichana KL, Gathinji M, et al. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 2009; 110: 156-62.