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J Neurooncol. 2017 Nov;135(2):285-297. doi: 10.1007/s11060-017-2573-y. Epub 2017 Jul 19.

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

Author information

1
Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674, Paris Cedex 14, France.
2
Paris Descartes University, Sorbonne Paris Cité, Paris, France.
3
Service de Neurologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France.
4
University of Texas Southwestern Medical Center, Dallas, TX, USA.
5
Department of Neurosurgery, University Hospital of Montpellier, Montpellier, France.
6
Inserm, U1051, Montpellier, France.
7
University Radiotherapy Department, Comprehensive Cancer Center Paul Strauss, Unicancer, Strasbourg, France.
8
Radiobiology Laboratory, EA 3440, Federation of Translationnal Medicine de Strasbourg (FMTS), Strasbourg University, Strasbourg, France.
9
Service of Neurosurgery D, Lyon Civil Hospitals, Pierre Wertheimer Neurological and Neurosurgical Hospital, Lyon, France.
10
Department of Neurosurgery, University Hospital Pontchaillou, Rennes, France.
11
Department of Neurosurgery, APHP Beaujon Hospital, Clichy, France.
12
Department of Neurosurgery, Maison Blanche Hospital, Reims University Hospital, Reims, France.
13
Department of Neurosurgery, Sainte Anne Military Teaching Hospital, Toulon, France.
14
Departement of Neurosurgery, University Hospital of Caen, University of Lower Normandy, Caen, France.
15
Department of Neurosurgery, University Hospital Jean Minjoz, Besancon, France.
16
Department of Neurosurgery, Amiens University Hospital, Amiens, France.
17
Department of Neurosurgery, Pasteur Hospital, Colmar, France.
18
Service de Neurochirurgie, CHU de Limoges, Limoges, France.
19
Department of Neurosurgery, Clairval Private Hospital, Marseille, France.
20
Service de Neurochirurgie A, CHU Pellegrin, Bordeaux Cedex, France.
21
Department of Neurosurgery, CHU d'Angers, Angers, France.
22
Department of Neurosurgery, Rouen University Hospital, Rouen, France.
23
Centre Psychiatrie et Neurosciences, Inserm, U894, Paris, France.
24
Department of Neurosurgery, University Medical Centre, Faculty of Medicine, University of Brest, Brest, France.
25
UMR911, CRO2, Aix-Marseille Université, Marseille, France.
26
Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674, Paris Cedex 14, France. johanpallud@hotmail.com.
27
Paris Descartes University, Sorbonne Paris Cité, Paris, France. johanpallud@hotmail.com.
28
Centre Psychiatrie et Neurosciences, Inserm, U894, Paris, France. johanpallud@hotmail.com.

Abstract

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.

KEYWORDS:

Aged patients; Geriatric assessment; Glioblastoma; Karnofsky performance status; Recurrence

PMID:
28726173
DOI:
10.1007/s11060-017-2573-y
[Indexed for MEDLINE]

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