1
|
Tagliaferri L, Mancini S, Lancellotta V, Dinapoli L, Capocchiano N, Cornacchione P, Scalise S, Autorino R, Campitelli M, Colloca GF, Fionda B, Rovirosa A, Macchia G, Ferrandina G, Gambacorta MA. The Impact of HAPPY (Humanity Assurance Protocol in Interventional Radiotherapy) on the Psychological Well-being of Gynecological Cancer Patients. Curr Radiopharm 2024; 17:168-173. [PMID: 37807408 DOI: 10.2174/0118744710247426230925054848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND HAPPY (Humanity Assurance Protocol in Interventional Radiotherapy) reports the necessity for gynecological cancer patients to undergo interventional radiotherapy (IRT, also called brachytherapy). The present paper has evaluated how some precautions may improve the psychological well-being of the patients during IRT. METHODS Patients with gynecological cancer undergoing IRT-HDR were analyzed. Patients answered three questionnaires before the IRT procedure (T0) and at the end of IRT (T1): Distress Thermometer (DT), Numerical Rating Scale for IRT procedure distress (NRS), and Hospital Anxiety and Depression Scale (HADS). Correlations have been calculated pairwise through pandas. corrwith with a Pearson algorithm, and the p-values have been calculated through scipy.stats.pearsonr. Plots have been generated through seaborn and matplotlib. A Wilcoxon test was used. RESULTS 55 patients were selected for this study. The median age of the patients was 64 (range, 39-84) years. 52 patients were with stage I endometrial cancer, whereas 3/3 patients with cervical cancer had locally advanced stages (IIB-IVA). 26 patients had a high education level (47.3%), and 38 were married or with a partner (69.1%). Only 14/55 (25.45%) patients were working. The HADS, DT, and NRS averages before the IRT procedure (T0) were 10.2, 3.8, and 4.3, respectively. After applying the HAPPY protocol, the HADS, DT, and NRS averages after IRT (T1) were 9.4, 3.4, and 2.6, respectively. The Wilcoxon signed rank test analysis showed a significant improvement in NRS (p < 0.00001) and HADS (p = 0.034). Living with a partner, parents or relatives was the only parameter statistically significantly associated with better DT pre-IRT (p = 0.04), HADS pre-IRT (p = 0.01), DT post-IRT (p = 0.01), and HADS post-IRT (p = 0.04). CONCLUSION In our study, the HAPPY protocol was associated with a significant reduction in patients' distress, anxiety, and discomfort.
Collapse
Affiliation(s)
- Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Silvia Mancini
- Università Cattolica del Sacro Cuore Sede di Roma, 00168, Rome, Italy
| | - Valentina Lancellotta
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Loredana Dinapoli
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
- UOS Psicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nikola Capocchiano
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Patrizia Cornacchione
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Sara Scalise
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Rosa Autorino
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Maura Campitelli
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Giuseppe Ferdinando Colloca
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Bruno Fionda
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Angeles Rovirosa
- Fonaments Clínics Department, University of Barcelona, 08036, Barcelona, Spain
- Radiation Oncology Department, Hospital Clínic Universitari, 08036, Barcelona, Spain
- Gynecologic Cancer Unit, Hospital Clínic Universitari, 08036, Barcelona, Spain
| | - Gabriella Macchia
- Gemelli Molise Hospital, Radiation Oncology Unit, Università Cattolica del Sacro Cuore, 86100, Campobasso, Italy
| | - Gabriella Ferrandina
- Università Cattolica del Sacro Cuore Sede di Roma, 00168, Rome, Italy
- Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore Sede di Roma, 00168, Rome, Italy
| |
Collapse
|
2
|
Casà C, Corvari B, Cellini F, Cornacchione P, D'Aviero A, Reina S, Di Franco S, Salvati A, Colloca GF, Cesario A, Patarnello S, Balducci M, Morganti AG, Valentini V, Gambacorta MA, Tagliaferri L. KIT 1 (Keep in Touch) Project-Televisits for Cancer Patients during Italian Lockdown for COVID-19 Pandemic: The Real-World Experience of Establishing a Telemedicine System. Healthcare (Basel) 2023; 11:1950. [PMID: 37444784 DOI: 10.3390/healthcare11131950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/09/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
To evaluate the adoption of an integrated eHealth platform for televisit/monitoring/consultation during the COVID-19 pandemic. METHODS During the lockdown imposed by the Italian government during the COVID19 pandemic spread, a dedicated multi-professional working group was set up in the Radiation Oncology Department with the primary aim of reducing patients' exposure to COVID-19 by adopting de-centralized/remote consultation methodologies. Each patient's clinical history was screened before the visit to assess if a traditional clinical visit would be recommended or if a remote evaluation was to be preferred. Real world data (RWD) in the form of patient-reported outcomes (PROMs) and patient reported experiences (PREMs) were collected from patients who underwent televisit/teleconsultation through the eHealth platform. RESULTS During the lockdown period (from 8 March to 4 May 2020) a total of 1956 visits were managed. A total of 983 (50.26%) of these visits were performed via email (to apply for and to upload of documents) and phone call management; 31 visits (1.58%) were performed using the eHealth system. Substantially, all patients found the eHealth platform useful and user-friendly, consistently indicating that this type of service would also be useful after the pandemic. CONCLUSIONS The rapid implementation of an eHealth system was feasible and well-accepted by the patients during the pandemic. However, we believe that further evidence is to be generated to further support large-scale adoption.
Collapse
Affiliation(s)
- Calogero Casà
- Fatebenefratelli Isola Tiberina-Gemelli Isola, Via di Ponte Quattro Capi 39, 00186 Rome, Italy
| | - Barbara Corvari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesco Cellini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Patrizia Cornacchione
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Andrea D'Aviero
- Mater Olbia Hospital, SS 125 Orientale Sarda, 07026 Olbia, Italy
| | - Sara Reina
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Silvia Di Franco
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessandra Salvati
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | | | - Alfredo Cesario
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Stefano Patarnello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Mario Balducci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Via Zamboni 33, 40126 Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| |
Collapse
|
3
|
Cao W, Xiong L, Meng L, Li Z, Hu Z, Lei H, Wu J, Song T, Liu C, Wei R, Shen L, Hong J. Prognostic analysis and nomogram construction for older patients with IDH-wild-type glioblastoma. Heliyon 2023; 9:e18310. [PMID: 37519736 PMCID: PMC10372674 DOI: 10.1016/j.heliyon.2023.e18310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
As many countries face an ageing population, the number of older patients with glioblastoma (GB) is increasing. Thus, there is an urgent need for prognostic models to aid in treatment decision-making and life planning. A total of 98 patients with isocitrate dehydrogenase (IDH)-wild-type GB aged ≥65 years were analysed from January 2012 to January 2020. Independent prognostic factors were identified by prognostic analysis. Using the independent prognostic factors for overall survival (OS), a nomogram was constructed by R software to predict the prognosis of older patients with IDH-wild-type GB. The concordance index (C-index) and receiver operating characteristic (ROC) curve were used to assess model discrimination, and the calibration curve was used to assess model calibration. Prognostic analysis showed that the extent of resection (EOR), adjusted Charlson comorbidity index (ACCI), O6-methylguanine-DNA methyltransferase (MGMT) methylation status, postoperative radiotherapy, and postoperative temozolomide (TMZ) chemotherapy were independent prognostic factors for OS. MGMT methylation status and subventricular zone (SVZ) involvement were independent prognostic factors for progression-free survival (PFS). A nomogram was constructed based on EOR, ACCI, MGMT methylation status, postoperative radiotherapy and postoperative TMZ chemotherapy to predict the 6-month, 12-month and 18-month OS of older patients with IDH-wild-type GB. The C-index of the nomogram was 0.72, and the ROC curves showed that the areas under the curve (AUCs) at 6, 12 and 18 months were 0.874, 0.739 and 0.779, respectively. The calibration plots showed that the nomogram was in good agreement with the actual observations in predicting the OS of older patients with IDH-wild-type GB. Older patients with IDH-wild-type GB can benefit from gross total resection (GTR), postoperative radiotherapy and postoperative TMZ chemotherapy. A high ACCI score and MGMT nonmethylation are poor prognostic factors. We constructed a nomogram including the ACCI to facilitate clinical decision-making and follow-up interval selection.
Collapse
Affiliation(s)
- Wenjun Cao
- Department of Hematology and Oncology, The First Hospital of Changsha, People's Republic of China
| | - Luqi Xiong
- Department of Oncology, Xiangya Hospital, Central South University, People's Republic of China
| | - Li Meng
- Department of Radiology, Xiangya Hospital, Central South University, People's Republic of China
| | - Zhanzhan Li
- Department of Oncology, Xiangya Hospital, Central South University, People's Republic of China
| | - Zhongliang Hu
- Department of Pathology, Xiangya Hospital, Central South University, People's Republic of China
| | - Huo Lei
- Department of Neurosurgery, Xiangya Hospital, Central South University, People's Republic of China
| | - Jun Wu
- Department of Neurosurgery, Xiangya Hospital, Central South University, People's Republic of China
| | - Tao Song
- Department of Neurosurgery, Xiangya Hospital, Central South University, People's Republic of China
| | - Chao Liu
- Department of Oncology, Xiangya Hospital, Central South University, People's Republic of China
| | - Rui Wei
- Department of Oncology, Xiangya Hospital, Central South University, People's Republic of China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, People's Republic of China
| | - Jidong Hong
- Department of Oncology, Xiangya Hospital, Central South University, People's Republic of China
| |
Collapse
|
4
|
Tramacere F, Lancellotta V, Casà C, Fionda B, Cornacchione P, Mazzarella C, De Vincenzo RP, Macchia G, Ferioli M, Rovirosa A, Gambacorta MA, Colosimo C, Valentini V, Iezzi R, Tagliaferri L. Assessment of Sexual Dysfunction in Cervical Cancer Patients after Different Treatment Modality: A Systematic Review. Medicina (B Aires) 2022; 58:medicina58091223. [PMID: 36143900 PMCID: PMC9504584 DOI: 10.3390/medicina58091223] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/25/2022] [Accepted: 09/02/2022] [Indexed: 10/27/2022] Open
Abstract
Background and Objectives: Cervical cancer is a leading cause of mortality among women. Chemo-radiation followed by interventional radiotherapy (IRT) is the standard of care for stage IB–IVA FIGO. Several studies have shown that image-guided adaptive IRT resulted in excellent local and pelvic control, but it is associated with vaginal toxicity and intercourse problems. The purpose of this review is to evaluate the dysfunctions of the sexual sphere in patients with cervical cancer undergoing different cervix cancer treatments. Materials and Methods: We performed a comprehensive literature search using Pub med, Scopus and Cochrane to identify all the full articles evaluating the dysfunctions of the sexual sphere. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Results: One thousand three hundred fifty-six women included in five studies published from 2016 to 2022 were analyzed. The median age was 50 years (range 46–56 years). The median follow-up was 12 months (range 0–60). Cervical cancer diagnosis and treatment (radiotherapy, chemotherapy and surgery) negatively affected sexual intercourse. Sexual symptoms such as fibrosis, strictures, decreased elasticity and depth and mucosal atrophy promote sexual dysfunction by causing frigidity, lack of lubrication, arousal, orgasm and libido and dyspareunia. Conclusions: Physical, physiological and social factors all contribute to the modification of the sexual sphere. Cervical cancer survivors who were irradiated have lower sexual and vaginal function than the normal population. Although there are cures for reducing discomfort, effective communication about sexual dysfunctions following treatment is essential.
Collapse
Affiliation(s)
- Francesco Tramacere
- S.C. Radioterapia, ASLBR Ospedale “A. Perrino” Brindisi, 72100 Brindisi, Italy
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00128 Rome, Italy
| | - Calogero Casà
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00128 Rome, Italy
| | - Bruno Fionda
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00128 Rome, Italy
- Correspondence: ; Tel.: +39-0630153754
| | - Patrizia Cornacchione
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00128 Rome, Italy
| | - Ciro Mazzarella
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00128 Rome, Italy
| | - Rosa Pasqualina De Vincenzo
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00128 Rome, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Martina Ferioli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, 40138 Bologna, Italy
| | - Angeles Rovirosa
- Department of Radiation Oncology, Hospital Clinic Barcelona, 08036 Barcelona, Spain
- Fonaments Clinics Department, Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Maria Antonietta Gambacorta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00128 Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00128 Rome, Italy
| | - Cesare Colosimo
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00128 Rome, Italy
- Department of Radiological Sciences, School of Medicine, Catholic University, 00128 Rome, Italy
| | - Vincenzo Valentini
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00128 Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00128 Rome, Italy
| | - Roberto Iezzi
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00128 Rome, Italy
- Department of Radiological Sciences, School of Medicine, Catholic University, 00128 Rome, Italy
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00128 Rome, Italy
| |
Collapse
|
5
|
Elderly Gliobastoma Patients: The Impact of Surgery and Adjuvant Treatments on Survival: A Single Institution Experience. Brain Sci 2022; 12:brainsci12050632. [PMID: 35625018 PMCID: PMC9139732 DOI: 10.3390/brainsci12050632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. Elderly glioblastoma (GBM) patients often show limited response to treatment and poor outcome. Here, we provide a case series of elderly GBM patients from our Institution, in whom we assessed the clinical characteristics, feasibility of surgical resection, response to adjuvant treatments, and outcome, along with the impact of comorbidities and clinical status on survival. Patients and Methods. We included patients ≥ 65-year-old. We collected information about clinical and molecular features, extent of resection, adjuvant treatments, treatment-related complications, and outcome. Results. We included 135 patients. Median age was 71 years. In total, 127 patients (94.0%) had a Karnofsky Performance Status (KPS) ≥70 and 61/135 (45.2%) a Charlson Comorbidity Score (CCI) > 3. MGMTp methylation was found in 70/135 (51.9%). Subtotal resections (STRs), gross-total resections (GTRs), and biopsies were 102 (75.6%), 10 (7.4%) and 23 (17.0%), respectively. Median progression-free survival and overall survival (mOS) were 8.0 and 10.5 months for the whole cohort. Notably, GTR and radio-chemotherapy with temozolomide in patients with MGMTp methylation were associated with significantly longer mOS (32.8 and 44.8 months, respectively). In a multivariable analysis, risk of death was affected by STR vs. GTR (HR 2.8, p = 0.002), MGMTp methylation (HR 0.55, p = 0.007), and KPS at baseline ≥70 (HR 0.43, p = 0.031). Conversely, CCI and post-surgical complications were not significant. Conclusions. Elderly GBM patients often have a dismal prognosis. However, it is possible to identify a subgroup with favourable clinical and molecular features, who benefit from GTR and radio-chemotherapy with temozolomide. A comprehensive prognostic score is needed to guide treatment modality and predict the outcome.
Collapse
|
6
|
Bruno F, Pellerino A, Palmiero R, Bertero L, Mantovani C, Garbossa D, Soffietti R, Rudà R. Glioblastoma in the Elderly: Review of Molecular and Therapeutic Aspects. Biomedicines 2022; 10:644. [PMID: 35327445 PMCID: PMC8945166 DOI: 10.3390/biomedicines10030644] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/22/2022] Open
Abstract
Glioblastoma (GBM) is the most aggressive primary brain tumour. As GBM incidence is associated with age, elderly people represent a consistent subgroup of patients. Elderly people with GBM show dismal prognosis (about 6 months) and limited response to treatments. Age is a negative prognostic factor, which correlates with clinical frailty, poorer tolerability to surgery or adjuvant radio-chemotherapy, and higher occurrence of comorbidities and/or secondary complications. The aim of this paper is to review the clinical and molecular characteristics, current therapeutic options, and prognostic factors of elderly patients with GBM.
Collapse
Affiliation(s)
- Francesco Bruno
- Division of Neuro-Oncology, Department of Neuroscience, University and City of Health and Science, 10126 Turin, Italy; (A.P.); (R.P.); (R.S.); (R.R.)
| | - Alessia Pellerino
- Division of Neuro-Oncology, Department of Neuroscience, University and City of Health and Science, 10126 Turin, Italy; (A.P.); (R.P.); (R.S.); (R.R.)
| | - Rosa Palmiero
- Division of Neuro-Oncology, Department of Neuroscience, University and City of Health and Science, 10126 Turin, Italy; (A.P.); (R.P.); (R.S.); (R.R.)
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy;
| | - Cristina Mantovani
- Division of Radiotherapy, Department of Oncology, University and City of Health and Science, 10126 Turin, Italy;
| | - Diego Garbossa
- Division of Neurosurgery, Department of Neuroscience, University and City of Health and Science, 10126 Turin, Italy;
| | - Riccardo Soffietti
- Division of Neuro-Oncology, Department of Neuroscience, University and City of Health and Science, 10126 Turin, Italy; (A.P.); (R.P.); (R.S.); (R.R.)
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, University and City of Health and Science, 10126 Turin, Italy; (A.P.); (R.P.); (R.S.); (R.R.)
- Department of Neurology, Castelfranco and Treviso Hospitals, 31100 Treviso, Italy
| |
Collapse
|
7
|
Gregucci F, Surgo A, Bonaparte I, Laera L, Ciliberti MP, Carbonara R, Gentile MA, Giraldi D, Calbi R, Caliandro M, Sasso N, D’Oria S, Somma C, Martinelli G, Surico G, Lombardi G, Fiorentino A. Poor-Prognosis Patients Affected by Glioblastoma: Retrospective Study of Hypofractionated Radiotherapy with Simultaneous Integrated Boost and Concurrent/Adjuvant Temozolomide. J Pers Med 2021; 11:jpm11111145. [PMID: 34834497 PMCID: PMC8619413 DOI: 10.3390/jpm11111145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/23/2021] [Accepted: 10/30/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Glioblastoma (GBM) is a very poor-prognosis brain tumor. To date, maximal excision followed by radiochemotherapy, in 30 fractions, is the standard approach. Limited data are present in the literature about hypofractionated radiotherapy (hypo-RT) in GBM poor prognosis patients. Thus, this retrospective study was conducted to evaluate efficacy and toxicity of hypo-RT with simultaneous integrated boost (SIB) in association with temozolomide (TMZ) in this patient setting. METHODS Poor-prognosis GBM patients underwent surgery (complete, subtotal or biopsy) followed by SIB-hypo-RT and concomitant/adjuvant TMZ. The prescription dose was 40.05 Gy (15 fractions) with a SIB of 52.5 Gy (3.5 Gy/fraction) on surgical cavity/residual/macroscopic disease. Volumetric modulated arc therapy was performed. RESULTS From July 2019 to July 2021, 30 poor-prognosis patients affected by GBM were treated by SIB-hypo-RT; 25 were evaluated in the present analysis due to a minimum follow up of 6 months. The median age and KPS were 65 years and 60%, respectively. At the median follow-up time of 15 months (range 7-24), median and 1-year overall survival and progression-free survival were 13 months and 54%, and 8.4 months and 23%, respectively. No acute or late neurological side effects of grade ≥ 2 were reported. Grade 3-4 hematologic toxicity occurred in three cases. CONCLUSION SIB-hypo-RT associated with TMZ in poor-prognosis patients affected by GBM is an effective and safe treatment. Prospective studies could be warranted.
Collapse
Affiliation(s)
- Fabiana Gregucci
- Department of Radiation Oncology, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (F.G.); (A.S.); (I.B.); (M.P.C.); (R.C.); (M.C.)
| | - Alessia Surgo
- Department of Radiation Oncology, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (F.G.); (A.S.); (I.B.); (M.P.C.); (R.C.); (M.C.)
| | - Ilaria Bonaparte
- Department of Radiation Oncology, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (F.G.); (A.S.); (I.B.); (M.P.C.); (R.C.); (M.C.)
| | - Letizia Laera
- Department of Medical Oncology, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (L.L.); (N.S.); (G.S.)
| | - Maria Paola Ciliberti
- Department of Radiation Oncology, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (F.G.); (A.S.); (I.B.); (M.P.C.); (R.C.); (M.C.)
| | - Roberta Carbonara
- Department of Radiation Oncology, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (F.G.); (A.S.); (I.B.); (M.P.C.); (R.C.); (M.C.)
| | - Maria Annunziata Gentile
- Department of Radiology, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (M.A.G.); (R.C.); (G.M.)
| | - David Giraldi
- Department of Neurosurgery, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (D.G.); (S.D.); (C.S.)
| | - Roberto Calbi
- Department of Radiology, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (M.A.G.); (R.C.); (G.M.)
| | - Morena Caliandro
- Department of Radiation Oncology, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (F.G.); (A.S.); (I.B.); (M.P.C.); (R.C.); (M.C.)
| | - Nicola Sasso
- Department of Medical Oncology, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (L.L.); (N.S.); (G.S.)
| | - Salvatore D’Oria
- Department of Neurosurgery, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (D.G.); (S.D.); (C.S.)
| | - Carlo Somma
- Department of Neurosurgery, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (D.G.); (S.D.); (C.S.)
| | - Gaetano Martinelli
- Department of Radiology, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (M.A.G.); (R.C.); (G.M.)
| | - Giammarco Surico
- Department of Medical Oncology, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (L.L.); (N.S.); (G.S.)
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Padova, Italy;
| | - Alba Fiorentino
- Department of Radiation Oncology, Miulli General Regional Hospital, 70021 Acquaviva delle Fonti, Bari, Italy; (F.G.); (A.S.); (I.B.); (M.P.C.); (R.C.); (M.C.)
- Correspondence: ; Tel.: +39-0803054608
| |
Collapse
|
8
|
Giaccherini L, Galaverni M, Renna I, Timon G, Galeandro M, Pisanello A, Russo M, Botti A, Iotti C, Ciammella P. Role of multidimensional assessment of frailty in predicting outcomes in older patients with glioblastoma treated with adjuvant concurrent chemo-radiation. J Geriatr Oncol 2019; 10:770-778. [DOI: 10.1016/j.jgo.2019.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/30/2019] [Accepted: 03/13/2019] [Indexed: 12/13/2022]
|
9
|
Kim LH, Chen YR. Risk Adjustment Instruments in Administrative Data Studies: A Primer for Neurosurgeons. World Neurosurg 2019; 128:477-500. [DOI: 10.1016/j.wneu.2019.04.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/25/2022]
|
10
|
Villani V, Tanzilli A, Telera SM, Terrenato I, Vidiri A, Fabi A, Zucchella C, Carapella CM, Marucci L, Casini B, Carosi M, Oppido PM, Pace A. Comorbidities in elderly patients with glioblastoma: a field-practice study. Future Oncol 2019; 15:841-850. [DOI: 10.2217/fon-2018-0524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Aim: This single-center study evaluated the effect of comorbidities on progression-free and overall survival in elderly patients with glioblastoma multiforme (GBM). Patients & methods: Comorbid conditions were identified in each patient with the modified version of the cumulative illness rating scale (CIRS). Results: Total of 118 patients with GBM were enrolled. An age of >75 years at diagnosis, high CIRS, comorbidity index and performance status play a predictive role on survival. Conclusion: Comorbidities play an important prognostic role in elderly patients with GBM, a factor too often neglected in clinical practice. If the prognostic role of comorbidity measured by CIRS on outcome will be confirmed, it would be interesting to add it in the algorithm for treatment choice in elderly GBM patients.
Collapse
Affiliation(s)
- Veronica Villani
- Neuro-Oncology Unit, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Antonio Tanzilli
- Neuro-Oncology Unit, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Stefano M Telera
- Division of Neurosurgery, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Irene Terrenato
- Biostatistic Unit, Scientific Direction, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Antonello Vidiri
- Service of Neuroradiology, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Alessandra Fabi
- Division of Medical Oncology, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Chiara Zucchella
- Neurology Unit, ‘Azienda Ospedaliera Universitaria Integrata’ Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Carmine M Carapella
- Division of Neurosurgery, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Laura Marucci
- Radiotherapy Unit, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Beatrice Casini
- Division of Neuropathology, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Mariantonia Carosi
- Division of Neuropathology, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Piero M Oppido
- Division of Neurosurgery, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Andrea Pace
- Neuro-Oncology Unit, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| |
Collapse
|
11
|
Martinez-Olivera R, Datsi A, Stallkamp M, Köller M, Kohtz I, Pintea B, Gousias K. Silencing of the nucleocytoplasmic shuttling protein karyopherin a2 promotes cell-cycle arrest and apoptosis in glioblastoma multiforme. Oncotarget 2018; 9:33471-33481. [PMID: 30323892 PMCID: PMC6173355 DOI: 10.18632/oncotarget.26033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/04/2018] [Indexed: 12/31/2022] Open
Abstract
We have previously shown that the nucleocytoplasmic carrier karyopherin a2 (KPNA2) is overexpressed in glioblastoma multiforme (GBM) whereas its expression is inversely associated with patient prognosis. However, the promoting role of KPNA2 in gliomagenesis is still poorly understood. This study aims to further elucidate this role of KPNA2 in in vitro GBM models. From four different tested GBM cell lines, the U87MG showed the highest proliferation, low adherence and outgrowth in 3D clusters as well as the highest expression of KPNA2, all features conferring greater malignant behaviour. Silencing of KPNA2 via siRNA interference in those cells significantly decreased their proliferative capacity (p = 0.001). We further observed both a significant cell cycle phase arrest (p = 0.040) and the promoting of cellular apoptosis (p = 0.016) as well as a strong trend (p = 0.062) for an inhibition of nuclear import of c-Myc. This study confirms that a higher expression of KPNA2 in GBM is associated with a more malignant phenotype also in in vitro models. While increased expression of KPNA2 promotes proliferation and survival of GBM tumour cells, silencing of KPNA2 conferred a less malignant behaviour. Our results strongly suggest that silencing of KPNA2 may play an important role in modulation of malignant features of GBM cells.
Collapse
Affiliation(s)
- Ramon Martinez-Olivera
- Department of Neurosurgery and Neurotraumatology, BG University Hospital Bergmannsheil, 44789 Bochum, Germany
| | - Angeliki Datsi
- Department of Laboratory for Neurosurgical Research, BG University Hospital Bergmannsheil, 44789 Bochum, Germany.,Institute for Transplantation Diagnostics and Cell Therapeutics, Heinrich-Heine University, 40225 Düsseldorf, Germany
| | - Maren Stallkamp
- Department of Laboratory for Neurosurgical Research, BG University Hospital Bergmannsheil, 44789 Bochum, Germany.,Medical School, Rheinische Friedrich-Wilhelms University of Bonn, 53121 Bonn, Germany
| | - Manfred Köller
- Department of Surgical Research, BG University Hospital Bergmannsheil, 44789 Bochum, Germany
| | - Isabelle Kohtz
- Department of Laboratory for Neurosurgical Research, BG University Hospital Bergmannsheil, 44789 Bochum, Germany
| | - Bogdan Pintea
- Department of Neurosurgery and Neurotraumatology, BG University Hospital Bergmannsheil, 44789 Bochum, Germany
| | - Konstantinos Gousias
- Department of Neurosurgery and Neurotraumatology, BG University Hospital Bergmannsheil, 44789 Bochum, Germany.,Department of Laboratory for Neurosurgical Research, BG University Hospital Bergmannsheil, 44789 Bochum, Germany.,Medical School, Rheinische Friedrich-Wilhelms University of Bonn, 53121 Bonn, Germany.,Department of Neurosurgery, University Hospital of Marburg, 35033 Marburg, Germany
| |
Collapse
|
12
|
Xie JC, Yang S, Liu XY, Zhao YX. Effect of marital status on survival in glioblastoma multiforme by demographics, education, economic factors, and insurance status. Cancer Med 2018; 7:3722-3742. [PMID: 30009575 PMCID: PMC6089174 DOI: 10.1002/cam4.1688] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/20/2018] [Accepted: 06/18/2018] [Indexed: 12/17/2022] Open
Abstract
The relationship between marital status and glioblastoma multiforme (GBM) has not been addressed in depth. Here, we aimed to investigate the association between marital status and survival in GBM. We searched the Surveillance, Epidemiology, and End Results (SEER) database and extracted the data of eligible patients diagnosed with GBM after 2004. Marital status was classified as married, divorced/separated, widowed, and single. A Kaplan-Meier test was conducted to compare the survival curves of different groups. Multivariate Cox regression was performed to evaluate overall survival (OS) and cause-specific survival (CSS) in different groups. Subgroup analysis was applied according to demographics, typical education and income levels in the locale, and insurance status. A total of 30 767 eligible patients were included. The median OS values were 9, 7, 3, 9 months in married, divorced/separated, widowed, and single patients, respectively. After adjustment for other covariates, married patients had better OS and CSS than other patients had. In addition to marital status, demographic factors, disease progression factors, local educational level, and insurance status were also associated with survival in GBM. Furthermore, subgroup analyses revealed the protective effect of marriage in most of the comparisons. Notably, the protective effect of marriage becomes more and more apparent as time goes on. The advantageous effect of marriage on GBM survival is especially prominent in patients who are male, older than 60 years of age, White, or living in middle-income counties. In conclusion, marital status is an independent prognostic factor for GBM.
Collapse
Affiliation(s)
- Jun-Chao Xie
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuai Yang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xue-Yuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan-Xin Zhao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
13
|
Asmaa A, Dixit S, Rowland-Hill C, Achawal S, Rajaraman C, O'Reilly G, Highley R, Hussain M, Baker L, Gill L, Morris H, Hingorani M. Management of elderly patients with glioblastoma-multiforme-a systematic review. Br J Radiol 2018; 91:20170271. [PMID: 29376741 DOI: 10.1259/bjr.20170271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The management of elderly patients with glioblastoma-multiforme (GBM) remains poorly defined with many experts in the past advocating best supportive care, in view of limited evidence on efficacy of more aggressive treatment protocols. There is randomised evidence (NORDIC and NA-O8 studies) to support the use of surgery followed by adjuvant monotherapy with either radiotherapy (RT) using hypofractionated regimes (e.g. 36 Gy in 6 fractions OR 40 Gy in 15 fractions) or chemotherapy with temozolomide (TMZ) in patients expressing methylation of promoter for O6-methylguanine-DNA methyltransferase enzyme. However, the role of combined-modality therapy involving the use of combined RT and TMZ protocols has remained controversial with data from the EORTC (European Organisation for Research and Treatment of Cancer)-NCIC (National Cancer Institute of Canada) studies indicating that patients more than 65 years of age may not benefit significantly from combining standard RT fractionation using 60 Gy in 30 fractions with concurrent and adjuvant TMZ. More recently, randomised data has emerged on combining hypofractionated RT with concurrent and adjuvant TMZ. We provide a comprehensive review of literature with the aim of defining an evidence-based algorithm for management of elderly glioblastoma-multiforme population.
Collapse
Affiliation(s)
- Almadani Asmaa
- 1 Faculty of Health Sciences, University of Hull , Hull , UK
| | - Sanjay Dixit
- 2 Queen centre of Oncology, Castle Hill hospital , Cottingham , UK
| | | | | | | | - Gerry O'Reilly
- 3 Department of Neurosurgery, Hull Royal Infirmary , Hull , UK
| | - Robin Highley
- 3 Department of Neurosurgery, Hull Royal Infirmary , Hull , UK
| | - Masood Hussain
- 3 Department of Neurosurgery, Hull Royal Infirmary , Hull , UK
| | - Louise Baker
- 3 Department of Neurosurgery, Hull Royal Infirmary , Hull , UK
| | - Lynne Gill
- 3 Department of Neurosurgery, Hull Royal Infirmary , Hull , UK
| | - Holly Morris
- 3 Department of Neurosurgery, Hull Royal Infirmary , Hull , UK
| | - Mohan Hingorani
- 4 Leeds Institue of Oncology, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| |
Collapse
|
14
|
Fiorentino A, Mazzola R, Giaj Levra N, Fersino S, Ricchetti F, Di Paola G, Gori S, Massocco A, Alongi F. Comorbidities and intensity-modulated radiotherapy with simultaneous integrated boost in elderly breast cancer patients. Aging Clin Exp Res 2017; 30:533-538. [DOI: 10.1007/s40520-017-0802-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/14/2017] [Indexed: 12/11/2022]
|
15
|
Ng WP, Liew BS, Idris Z, Rosman AK. Fluorescence-Guided versus Conventional Surgical Resection of High Grade Glioma: A Single-Centre, 7-Year, Comparative Effectiveness Study. Malays J Med Sci 2017; 24:78-86. [PMID: 28894407 DOI: 10.21315/mjms2017.24.2.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/08/2016] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND High grade gliomas (HGGs) are locally invasive brain tumours that carry a dismal prognosis. Although complete resection increases median survival, the difficulty in reliably demonstrating the tumour border intraoperatively is a norm. The Department of Neurosurgery, Hospital Sungai Buloh is the first public hospital in Malaysia to overcome this problem by adopting fluorescence-guided (FG) surgery using 5-aminolevulinic acid (5-ALA). METHODS A total of 74 patients with histologically proven HGGs treated between January 2008 and December 2014, who fulfilled the inclusion criteria, were enrolled. Kaplan-Meier survival estimates and Cox proportional hazard regression were used. RESULTS Significant longer survival time (months) was observed in the FG group compared with the conventional group (12 months versus 8 months, P < 0.020). Even without adjuvant therapy, HGG patients from FG group survived longer than those from the conventional group (8 months versus 3 months, P = 0.006). No significant differences were seen in postoperative Karnofsky performance scale (KPS) between the groups at 6 weeks and 6 months after surgery compared to pre-operative KPS. Cox proportional hazard regression identified four independent predictors of survival: KPS > 80 (P = 0.010), histology (P < 0.001), surgical method (P < 0.001) and adjuvant therapy (P < 0.001). CONCLUSION This study showed a significant clinical benefit for HGG patients in terms of overall survival using FG surgery as it did not result in worsening of post-operative function outcome when compared with the conventional surgical method. We advocate a further multicentered, randomised controlled trial to support these findings before FG surgery can be implemented as a standard surgical adjunct in local practice for the benefit of HGG patients.
Collapse
Affiliation(s)
- Wei Ping Ng
- Department of Neurosurgery, Hospital Sungai Buloh, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Boon Seng Liew
- Department of Neurosurgery, Hospital Sungai Buloh, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia
| | - Zamzuri Idris
- Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Azmin Kass Rosman
- Department of Neurosurgery, Hospital Sungai Buloh, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia
| |
Collapse
|
16
|
Kim SK, Kim TM, Lee ST, Lee SH, Heo DS, Kim IH, Kim DG, Jung HW, Choi SH, Lee SH, Park CK. The survival significance of a measurable enhancing lesion after completing standard treatment for newly diagnosed glioblastoma. J Clin Neurosci 2016; 34:145-150. [PMID: 27475318 DOI: 10.1016/j.jocn.2016.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/18/2016] [Accepted: 06/04/2016] [Indexed: 11/17/2022]
Abstract
The goal of this study was to analyze the survival outcome according to the treatment response after completing standard treatment protocol for newly diagnosed glioblastoma (GBM) and to suggest a patient who should be considered for further treatment. After approving by our Institutional Review Board, 57 patients (38 male, 19 female; median age, 52years; age range, 16-81years) with newly diagnosed GBM who completed standard treatment protocol were examined retrospectively. According to the treatment response using the RANO criteria, there were 20 patients with complete response (CR), five patients with partial response (PR), 13 patients with stable disease (SD) and 19 patients with progressive disease (PD) after the completion of standard treatment. Patients (PR+SD+PD) with a measurable enhancing lesion were categorized the MEL group (n=37). We analyzed the difference of survival outcome between CR group and MEL group. The median progression-free survival (PFS) in the CR group was significantly better than that of the MEL group (18.0months vs. 3.0months, p=0.004). The median overall survival (OS) was also significantly longer in the CR group (25.0months vs. 15.0months, p=0.005). However, there was no significant difference in the survival outcome of the CR group compared with that of the subset of MEL group patients who showed PR or SD. Poor survival outcome was found only in MEL group patients who exhibited progression. Patients with a measurable enhancing lesion showing progression after completion of standard treatment protocol are appropriate candidates for further treatment.
Collapse
Affiliation(s)
- Sung Kwon Kim
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Changwon Gyeongsang National University Hospital, Changwon, South Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Se-Hoon Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Gyu Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Hee-Won Jung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Sang Hyung Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, South Korea.
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.
| |
Collapse
|
17
|
Fiorentino A, Mazzola R, Giaj Levra N, Ricchetti F, Fersino S, Alongi F. A Plethora of Therapeutic Opportunities for Elderly Patients With Cancer: A Nontrivial Choice. J Clin Oncol 2016; 34:1963-4. [DOI: 10.1200/jco.2015.65.2370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
18
|
Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes. J Neurooncol 2015; 126:175-183. [PMID: 26459327 DOI: 10.1007/s11060-015-1957-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/06/2015] [Indexed: 01/23/2023]
Abstract
Despite moderate improvements in outcome of glioblastoma after first-line treatment with chemoradiation recent clinical trials failed to improve the prognosis of recurrent glioblastoma. In the absence of a standard of care we aimed to investigate institutional treatment strategies to identify similarities and differences in the pattern of care for recurrent glioblastoma. We investigated re-treatment criteria and therapeutic pathways for recurrent glioblastoma of eight neuro-oncology centres in Switzerland having an established multidisciplinary tumour-board conference. Decision algorithms, differences and consensus were analysed using the objective consensus methodology. A total of 16 different treatment recommendations were identified based on combinations of eight different decision criteria. The set of criteria implemented as well as the set of treatments offered was different in each centre. For specific situations, up to 6 different treatment recommendations were provided by the eight centres. The only wide-range consensus identified was to offer best supportive care to unfit patients. A majority recommendation was identified for non-operable large early recurrence with unmethylated MGMT promoter status in the fit patients: here bevacizumab was offered. In fit patients with late recurrent non-operable MGMT promoter methylated glioblastoma temozolomide was recommended by most. No other majority recommendations were present. In the absence of strong evidence we identified few consensus recommendations in the treatment of recurrent glioblastoma. This contrasts the limited availability of single drugs and treatment modalities. Clinical situations of greatest heterogeneity may be suitable to be addressed in clinical trials and second opinion referrals are likely to yield diverging recommendations.
Collapse
|
19
|
Repeat-surgery at Glioblastoma recurrence, when and why to operate? Clin Neurol Neurosurg 2015; 136:89-94. [DOI: 10.1016/j.clineuro.2015.05.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 11/19/2022]
|
20
|
Giaj Levra N, Fiorentino A, Fersino S, Ricchetti F, Mazzola R, Alongi F. In Regard to Arvold et al. Int J Radiat Oncol Biol Phys 2015; 93:217-8. [DOI: 10.1016/j.ijrobp.2015.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
|
21
|
Incidence, risk factors, and reasons for hospitalization among glioblastoma patients receiving chemoradiation. J Neurooncol 2015; 124:137-46. [PMID: 26033544 DOI: 10.1007/s11060-015-1820-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 05/22/2015] [Indexed: 12/21/2022]
Abstract
Despite a high symptom burden, little is known about the incidence or predictors of hospitalization among glioblastoma patients, including risks during chemoradiation (CRT). We studied 196 consecutive newly diagnosed glioblastoma patients treated at our institution from 2006-2010. Toxicity data were reviewed during and after the CRT phase, defined as the period between diagnosis and 6 weeks after radiotherapy completion. Logistic regression and proportional hazards modeling identified predictors of hospitalization and overall survival (OS). Median age was 59 years (range, 23-90) and 83 % had Karnofsky performance status (KPS) score ≥ 70. Twenty-six percent of patients underwent gross total resection, 77 % received ≥ 59.4 Gy of radiotherapy, and 89 % received concurrent temozolomide. Median OS was 15.6 months (IQR, 8.5-26.8 months). Forty-three percent of patients were hospitalized during the CRT phase; OS was 10.7 vs. 17.8 months for patients who were vs. were not hospitalized, respectively (P < .001). Nearly half of the hospitalizations were due to generalized weakness (17 % of hospitalizations), seizures (16 %), or venous thromboembolism (13 %). On multivariate analysis, age (odds ratio [OR], 1.03; 95 % CI, 1.002-1.060; P = .034) and KPS (OR, 0.95; 95 % CI, 0.93-0.97; P < .001) were associated with risk of hospitalization. Hospitalization during the CRT phase was associated with decreased OS (adjusted hazard ratio, 1.47; 95 % CI, 1.01-2.13; P = .043), after adjustment for known prognostic factors. Hospitalization during the CRT phase is common among glioblastoma patients in the temozolomide era and is associated with shorter overall survival.
Collapse
|
22
|
Very elderly (>80 years), frail patients with muscle-invasive bladder cancer and comorbidities: is curative irradiation feasible? TUMORI JOURNAL 2015; 101:609-13. [PMID: 25983093 DOI: 10.5301/tj.5000361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate clinical results in elderly and frail patients with bladder cancer treated with curative conformal irradiation alone. METHODS The records of ambulatory frail elderly patients, age >80 years, Charlson Comorbidity Index (CCI) >5, with invasive bladder cancer, were retrospectively analyzed. The patients were irradiated with curative intent. Acute and late toxicities were evaluated. RESULTS A total of 27 ambulatory patients were treated. Median age was 84.5 years and a median CCI of 6.5 was recorded. Median delivered radiation dose was 64 Gy. All patients completed the planned treatment. Grade 1-2 gastrointestinal (GI) and genitourinary (GU) toxicities were observed in 55.5% of patients (15/27). At the last follow-up, no late G3+ toxicities have been observed, with G1-2 toxicities reported in 11.1% of patients (3/27). Higher values of CCI were associated with higher acute GU/GI toxicities; there was a correlation between CCI and acute GU toxicity (r = 0.43, p = 0.027). The mean survival time was 23.5 months (95% confidence interval 20.9-26.1) and no median was reached. Locoregional disease-free events and metastasis-free survival showed a 2-year actuarial rate of 90% and 87%, respectively, with an actuarial 2-year overall survival of 84.5%. CONCLUSIONS Our results demonstrate safety and feasibility of curative radiation therapy in very elderly and frail patients with bladder cancer using 3D conformal radiation therapy.
Collapse
|
23
|
Abstract
The incidence of glioblastoma (GBM) is increasing among the elderly, who now account for up to half of all the adult cases of GBM. This trend has resulted in the recent development of clinical research specifically dedicated to this fragile population. Some studies have investigated surgical resection, radiotherapy and chemotherapy with temozolomide, and ongoing research is currently addressing the use of combined radiochemotherapy in this population. Although older patients with GBM have a significantly worse life expectancy compared with their younger counterparts, etiologic treatments should not be withheld from these patients solely because of their age. On the contrary, results from prospective studies suggest that active care of these patients has a significant positive impact on survival without affecting quality of life or cognition. To optimize both symptomatic and etiologic treatment, neuro-oncology multidisciplinary teams must take into account performance and cognitive status, the resectability of the tumor, and associated comorbidities.
Collapse
Affiliation(s)
- Jaime Gállego Pérez-Larraya
- Department of Neurology, Neuro-Oncology Unit, Clínica Universidad de Navarra, Universidad de Navarra, Av. Pío XII 36, 31008 Pamplona, Spain
| | | |
Collapse
|
24
|
Regarding Ening et al. Charlson comorbidity index: an additional prognostic parameter for preoperative glioblastoma patient stratification. J Cancer Res Clin Oncol 2015; 141:1139-40. [DOI: 10.1007/s00432-015-1944-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
|
25
|
Can Elderly Patients With Newly Diagnosed Glioblastoma be Enrolled in Radiochemotherapy Trials? Am J Clin Oncol 2015; 38:23-7. [DOI: 10.1097/coc.0b013e3182868ea2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
26
|
Ening G, Osterheld F, Capper D, Schmieder K, Brenke C. Charlson comorbidity index: an additional prognostic parameter for preoperative glioblastoma patient stratification. J Cancer Res Clin Oncol 2015; 141:1131-7. [PMID: 25577223 DOI: 10.1007/s00432-014-1907-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/25/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Dismal glioblastoma (GB) patient outcome calls for the elucidation of further reliable predictors of prognosis. Established "biomarkers," age and functional status, employed in today's patient stratification have limits in fingerprinting this heterogeneous tumor entity. We aimed at ascertaining additional prognostic factors that may facilitate patient stratification for surgery. METHODS A retrospective review of 233 consecutive adult patients operated on for newly diagnosed GB at a single tertiary institution over a 5-year period (2006-2011) was conducted. Modern defined outcome associating factors recorded included demographics (preoperative age, gender, signs, symptoms, comorbidity status quantified by the Charlson comorbidity index (CCI), functional status computed by the Karnofsky performance scale (KPS)), tumor characteristics (size, location, isocitrate dehydrogenase mutation, and O-6-methylguanine-DNA methyltransferase promoter methylation status), and treatment parameters (volumetrically quantified extent of resection and adjuvant therapy). Survival analysis was performed by the Kaplan-Maier method. Influence of variables was evaluated using log-rank test. RESULTS Median neuroradiographic evidence of tumor progression was 6 months after surgery (range 0-72). The median overall survival was 9.5 months (range 0-72). Age > 65 years, KPS ≤ 70, and CCI > 3 were significantly associated with both poor OS (each p < 0.0001) and PFS (p < 0.0001, p < 0.001 and p < 0.002), respectively. Also, patients older than 65 years significantly had a CCI > 3 (p < 0.0001). CONCLUSIONS Our data evidence that aside established prognostic parameters (age and KPS) for GB patient outcome, the CCI additionally significantly impacts outcome and may be employed for preoperative patient stratification.
Collapse
Affiliation(s)
- G Ening
- Department of Neurosurgery, Knappschafts-Krankenhaus Bochum-Langendreer, Ruhr-University of Bochum, In der Schornau 23-25, 44892, Bochum, Germany,
| | | | | | | | | |
Collapse
|
27
|
Ening G, Osterheld F, Capper D, Schmieder K, Brenke C. Risk factors for glioblastoma therapy associated complications. Clin Neurol Neurosurg 2015; 134:55-9. [PMID: 25942630 DOI: 10.1016/j.clineuro.2015.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 12/24/2014] [Accepted: 01/03/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Thromboembolic events, seizures, neurologic symptoms and adverse effects from corticosteroids and chemotherapies are frequent clinical complications seen in Glioblastoma (GB) patients. The exact impact these have on dismal patient outcome has not been fully elucidated. We aimed at assessing treatment associated complications, evaluating the impact on survival and defining risk factors. METHODS Two hundred and thirty three consecutive adult patients operated on for newly diagnosed GB at a single tertiary institution over a 5-year-period (2006-2011) were assessed. Demographic parameters (age, gender, comorbidity status quantified by the Charlson-comorbidity-index (CCI), functional status computed by the Karnofsky Performance Scale (KPS), tumor characteristics (size, location, IDH-1 mutation and MGMT-Promotor-methylation-status) and treatment parameters (volumetrically quantified extent of resection and adjuvant therapy) were retrospectively reviewed. Complications assessed were recorded as neurological (N), surgical (S) and medical (M). Independent risk factor analysis was performed by the univariate and multivariate logistic regression method. Survival analysis was plotted by the Kaplan-Meier-method, influence of complication occurrence was evaluated by the log-rank test. RESULTS One hundred and fifty nine (68.2%) patients had a total of 281 complications (90 N, 174 M and 17 S). Univariate analysis identified age (P=0.003), KPS<70 (P=0.002), CCI>3 (P=0.03), eloquent tumor location (P=0.001) and therapy other than the standard radio-chemotherapy with temozolomide therapy (P=0.034) as risk factors for complications. Multivariate analysis extracted the eloquent tumor location (P=0.007, odds ratio 1.94) as a significant predictor for complications. Having a complication significantly decreased patient survival (P=0.015). CONCLUSIONS Complications significantly decrease GB patient survival. Age, poor functional status, other than standard adjuvant therapy and eloquent tumor location proved as significant risk factors for encountering a therapy associated complication. Not extensive surgery or tumor size but surgery at eloquent locations impacts complication occurrence the strongest with a 2 fold increased complication occurrence risk.
Collapse
Affiliation(s)
- Genevieve Ening
- Department of Neurosurgery, Knappschafts-Krankenhaus Bochum-Langendreer, Ruhr-University of Bochum, In der Schornau 23-25, 44892 Bochum, Germany; Department of Neurosurgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1, 68167 Mannheim, Germany.
| | - Fransiska Osterheld
- Department of Neurosurgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1, 68167 Mannheim, Germany
| | - David Capper
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Kirsten Schmieder
- Department of Neurosurgery, Knappschafts-Krankenhaus Bochum-Langendreer, Ruhr-University of Bochum, In der Schornau 23-25, 44892 Bochum, Germany; Department of Neurosurgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1, 68167 Mannheim, Germany
| | - Christopher Brenke
- Department of Neurosurgery, Knappschafts-Krankenhaus Bochum-Langendreer, Ruhr-University of Bochum, In der Schornau 23-25, 44892 Bochum, Germany; Department of Neurosurgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1, 68167 Mannheim, Germany
| |
Collapse
|
28
|
Abstract
Although glioblastoma occurs mostly in elderly patients, there is a paucity of trials addressing patients older than 70 years of age. Age, by itself, constitutes an unfavorable prognostic factor, which is probably due to unpropitious genetic features, but also due to iatrogenic defeatism. However, many retrospective studies report a survival benefit achieved by aggressive surgical resection seeking gross total removal of contrast-enhancing tumor according to preoperative MRI. Combined radiochemotherapy with concomitant and adjuvant temozolomide has not been investigated in prospective trials. Numerous retrospective studies and a meta-analysis suggest benefit from combined treatment. Prospective randomized trials only evaluated either temozolomide or radiotherapy. Single-treatment hypofractionated radiotherapy performed superior to conventional fractionation. In patients with methylated MGMT promoter, first-line dose-dense temozolomide facilitates prolonged survival. However, there is no comparison with combined radiochemotherapy as the standard-of-care in adult patients. Comorbidity is more frequent in elderly patients, but does not correlate with preterm termination of temozolomide treatment. This review article compiles data proposing a straightforward glioblastoma treatment, irrespective of age.
Collapse
Affiliation(s)
- Florian Stockhammer
- Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| |
Collapse
|
29
|
De Bonis P, Mangiola A, Pompucci A, Porso M, Anile C. High-grade glioma: elderly patients, older treatments. Expert Rev Neurother 2014; 12:1293-6. [DOI: 10.1586/ern.12.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
30
|
Fiorentino A, Bonis PD, Chiesa S, Balducci M, Fusco V. Elderly patients with glioblastoma: the treatment challenge. Expert Rev Neurother 2014; 13:1099-105. [DOI: 10.1586/14737175.2013.840419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
31
|
Fiorentino A, Balducci M, Chiesa S. Which therapeutic approach is feasible for elderly people with glioblastoma? CNS Oncol 2014; 3:9-11. [DOI: 10.2217/cns.13.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alba Fiorentino
- Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, Negrar-Verona, Italy
| | - Mario Balducci
- Radiation Oncology Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Silvia Chiesa
- Radiation Oncology Department, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
32
|
Treatment outcomes in glioblastoma patients aged 76 years or older: a multicenter retrospective cohort study. J Neurooncol 2013; 116:299-306. [PMID: 24173683 DOI: 10.1007/s11060-013-1291-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
Abstract
Age is one of the most important prognostic factors in glioblastoma patients, but no standard treatment has been established for elderly patients with this condition. We therefore conducted a retrospective cohort study to evaluate treatment regimens and outcomes in elderly glioblastoma patients. The study population consisted of 79 glioblastoma patients aged ≥ 76 years (median age 78.0 years; 34 men and 45 women). The median preoperative Karnofsky performance status (KPS) score was 60. Surgical procedures were classified as biopsy (31 patients, 39.2 %), <95 % resection of the tumor (21 patients, 26.9 %), and ≥ 95 % resection of the tumor (26 patients, 33.3 %). Sixty-seven patients (81.0 %) received radiotherapy and 45 patients (57.0 %) received chemotherapy. The median overall progression-free survival time was 6.8 months, and the median overall survival time was 9.8 months. Patients aged ≥ 78 years were significantly less likely to receive radiotherapy (p = 0.004). Patients with a postoperative KPS score of ≥ 60 were significantly more likely to receive maintenance chemotherapy (p = 0.008). Multivariate analyses identified two independent prognostic factors: postoperative KPS score ≥ 60 (hazard ratio [HR] = 0.531, 95 % confidence interval [CI] 0.315-0.894, p = 0.017) and temozolomide therapy (HR = 0.442, 95 % CI 0.25-0.784, p < 0.001).The findings of this study suggest that postoperative KPS score is an important prognostic factor for glioblastoma patients aged ≥ 76 years, and that these patients may benefit from temozolomide therapy.
Collapse
|
33
|
Pontes LDB, Loureiro LVM, Koch LO, Karnakis T, Guendelmann RAK, Weltman E, Malheiros SMF. Patterns of care and outcomes in elderly patients with glioblastoma in Sao Paulo, Brazil: A retrospective study. J Geriatr Oncol 2013; 4:388-93. [DOI: 10.1016/j.jgo.2013.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 05/02/2013] [Accepted: 07/23/2013] [Indexed: 12/27/2022]
|
34
|
Nguyen LT, Touch S, Nehme-Schuster H, Antoni D, Eav S, Clavier JB, Bauer N, Vigneron C, Schott R, Kehrli P, Noël G. Outcomes in newly diagnosed elderly glioblastoma patients after concomitant temozolomide administration and hypofractionated radiotherapy. Cancers (Basel) 2013; 5:1177-98. [PMID: 24202340 PMCID: PMC3795385 DOI: 10.3390/cancers5031177] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/12/2013] [Accepted: 09/10/2013] [Indexed: 12/05/2022] Open
Abstract
This study aimed to analyze the treatment and outcomes of older glioblastoma patients. Forty-four patients older than 70 years of age were referred to the Paul Strauss Center for chemotherapy and radiotherapy. The median age was 75.5 years old (range: 70–84), and the patients included 18 females and 26 males. The median Karnofsky index (KI) was 70%. The Charlson indices varied from 4 to 6. All of the patients underwent surgery. O6-methylguanine–DNA methyltransferase (MGMT) methylation status was determined in 25 patients. All of the patients received radiation therapy. Thirty-eight patients adhered to a hypofractionated radiation therapy schedule and six patients to a normofractionated schedule. Neoadjuvant, concomitant and adjuvant chemotherapy regimens were administered to 12, 35 and 20 patients, respectively. At the time of this analysis, 41 patients had died. The median time to relapse was 6.7 months. Twenty-nine patients relapsed, and 10 patients received chemotherapy upon relapse. The median overall survival (OS) was 7.2 months and the one- and two-year OS rates were 32% and 12%, respectively. In a multivariate analysis, only the Karnofsky index was a prognostic factor. Hypofractionated radiotherapy and chemotherapy with temozolomide are feasible and acceptably tolerated in older patients. However, relevant prognostic factors are needed to optimize treatment proposals.
Collapse
Affiliation(s)
- Ludovic T. Nguyen
- Neurology Department, CHU Hautepierre, rue Molière, Strasbourg 67000, France; E-Mail:
| | - Socheat Touch
- Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065, France; E-Mails: (S.T.); (D.A.); (J.B.C.); (N.B.); (C.V.)
- Radiation Oncology Department, Soviet-Khmer Friendship Hospital, Pnom-Pehn 12400, Cambodia; E-Mail:
| | - Hélène Nehme-Schuster
- Oncology Geriatric Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065, France; E-Mail:
| | - Delphine Antoni
- Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065, France; E-Mails: (S.T.); (D.A.); (J.B.C.); (N.B.); (C.V.)
| | - Sokha Eav
- Radiation Oncology Department, Soviet-Khmer Friendship Hospital, Pnom-Pehn 12400, Cambodia; E-Mail:
| | - Jean-Baptiste Clavier
- Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065, France; E-Mails: (S.T.); (D.A.); (J.B.C.); (N.B.); (C.V.)
| | - Nicolas Bauer
- Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065, France; E-Mails: (S.T.); (D.A.); (J.B.C.); (N.B.); (C.V.)
| | - Céline Vigneron
- Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065, France; E-Mails: (S.T.); (D.A.); (J.B.C.); (N.B.); (C.V.)
| | - Roland Schott
- Oncology Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065, France; E-Mail:
| | - Pierre Kehrli
- Neurosurgery Department, CHU Hautepierre, rue Molière, Strasbourg 67000, France; E-Mail:
| | - Georges Noël
- Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065, France; E-Mails: (S.T.); (D.A.); (J.B.C.); (N.B.); (C.V.)
- Laboratoire EA 3430, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg 67000, France
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +33-(0)3-88-25-24-71; Fax: +33-(0)3-88-25-85-08
| |
Collapse
|
35
|
Radiotherapy plus concurrent or sequential temozolomide for glioblastoma in the elderly: a meta-analysis. PLoS One 2013; 8:e74242. [PMID: 24086323 PMCID: PMC3782499 DOI: 10.1371/journal.pone.0074242] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/31/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Many physicians are reluctant to treat elderly glioblastoma (GBM) patients as aggressively as younger patients, which is not evidence based due to the absence of validated data from primary studies. We conducted a meta-analysis to provide valid evidence for the use of the aggressive combination of radiotherapy (RT) and temozolomide (TMZ) in elderly GBM patients. METHODS A systematic literature search was conducted using the PubMed, EMBASE and Cochrane databases. Studies comparing combined RT/TMZ with RT alone in elderly patients (≥65 years) with newly diagnosed GBM were eligible for inclusion. RESULTS No eligible randomized trials were identified. Alternatively, a meta-analysis of nonrandomized studies (NRSs) was performed, with 16 studies eligible for overall survival (OS) analysis and nine for progression-free survival (PFS) analysis. Combined RT/TMZ was shown to reduce the risk of death and progression in elderly GBM patients compared with RT alone (OS hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.48-0.72; PFS: HR 0.58, 95% CI 0.41-0.84). Evaluable patients were reported to tolerate combined treatment but certain toxicities, and especially hematological toxicities, were more frequently observed. Limited data on O6-methylguanine-DNA methyltransferase (MGMT) promoter status and quality of life were reported. CONCLUSION The meta-analysis of NRSs provided level 2a evidence (Oxford Centre for Evidence-Based Medicine) that combined RT/TMZ conferred a clear survival benefit on a selection of elderly GBM patients who had a favorable prognosis (e.g., extensive resection, favorable KPS). Toxicities were more frequent but acceptable. Future randomized trials are warranted to justify a definitive conclusion.
Collapse
|
36
|
Fiorentino A, Caivano R, Pedicini P, Fusco V. Clinical target volume definition for glioblastoma radiotherapy planning: magnetic resonance imaging and computed tomography. Clin Transl Oncol 2013; 15:754-8. [DOI: 10.1007/s12094-012-0992-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/20/2012] [Indexed: 11/29/2022]
|
37
|
Do comorbidity influences acute toxicity and outcome in elderly patients with endometrial cancer treated by adjuvant radiotherapy plus brachytherapy? Clin Transl Oncol 2013; 15:665-9. [PMID: 23359175 DOI: 10.1007/s12094-012-0986-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To correlate comorbidity and acute radiation toxicity in elderly patients treated with adjuvant external beam radiotherapy (EBRT) plus brachytherapy-high dose rate (HDR-BRT) for endometrial cancer (EC). METHODS Endometrial cancer patients over 65 were treated and evaluated for comorbidity assessment with ACE-27 and Charlson comorbidity index (CCI). EBRT total dose was 45-50.4 Gy (1.8 Gy/day). The vault vagina boost of dose was performed by HDR-BRT with 2/3 fractions with a total dose of 10-15 Gy. RESULTS From 2008 to 2011, 35 patients were analyzed. Eighteen patients (51.43 %) had not ACE-27 comorbidity; while 27 patients (77.14 %) had CCI lower than three. During treatment, acute toxicity was mild and not influenced by the comorbidity score. Two-year Progression Free and Overall Survival were 69 and 80 %. ACE-27 and CCI did not affect progression-free survival (p = 0.51, p = 0.3) and OS (p = 0.26, p = 0.5). CONCLUSION External beam radiotherapy plus BRT-HDR are well tolerated in EC elderly with good performance status and low comorbidity profile.
Collapse
|
38
|
Radiochemotherapy and brachytherapy could be the standard treatment for anal canal cancer in elderly patients? A retrospective single-centre analysis. Med Oncol 2013; 30:402. [DOI: 10.1007/s12032-012-0402-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/05/2012] [Indexed: 12/27/2022]
|
39
|
Fiorentino A, Balducci M, Chiesa S, Fusco V. Elderly people with glioblastoma. Lancet Oncol 2012; 13:e327-8; author reply e329. [DOI: 10.1016/s1470-2045(12)70276-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|