1
|
Kuntz L, Noel G, Antoni D. [Hypofractioned radiotherapy in elderly patient with glioblastoma]. Cancer Radiother 2018; 22:647-652. [PMID: 30197025 DOI: 10.1016/j.canrad.2018.07.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 11/19/2022]
Abstract
Glioblastoma is the most frequent primary brain tumor, with more than half of all patients being at least 65 years old. The treatment of the elderly in this pathology represents therefore a considerable challenge for oncologists and radiation therapists. However, in most clinical trials, age is a non-eligible criterial. In the last ten years, geriatric therapeutic trials have been multiplied. The treatment of glioblastoma consists of adjuvant chemoradiotherapy. In elderly patients, the evaluation of performans status and the molecular characteristics of the tumor are important factors in order to propose the appropriate treatment in terms of efficacy and toxicity.
Collapse
Affiliation(s)
- L Kuntz
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de-la-Porte de l'Hôpital, 67065 Strasbourg, France
| | - G Noel
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de-la-Porte de l'Hôpital, 67065 Strasbourg, France; CNRS, IPHC UMR 7178, centre Paul-Strauss, université de Strasbourg, Unicancer, 67000 Strasbourg, France
| | - D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de-la-Porte de l'Hôpital, 67065 Strasbourg, France; CNRS, IPHC UMR 7178, centre Paul-Strauss, université de Strasbourg, Unicancer, 67000 Strasbourg, France.
| |
Collapse
|
2
|
Chaskis E, Luce S, Goldman S, Sadeghi N, Melot C, De Witte O, Devriendt D, Lefranc F. [Early postsurgical temozolomide treatment in newly diagnosed bad prognosis glioblastoma patients: Feasibility study]. Bull Cancer 2018; 105:664-670. [PMID: 29937336 DOI: 10.1016/j.bulcan.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 05/04/2018] [Accepted: 05/18/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Despite the combined adjuvant treatment of radiotherapy plus chemotherapy with temozolomide (TMZ) followed by 6 cycles of temozolomide after surgery, the prognosis of patients with glioblastoma remains poor. We conducted a monocentric prospective study to explore the tolerance and potential efficacy of an early temozolomide cycle after surgery. METHOD Patients with newly diagnosed glioblastoma (unmutated IDH1) and of poor prognosis (age>50 years, biopsy or partial resection or unmethylated MGMT promoter) were prospectively included from June 2014 to 2017. They all received a cycle of 5 days of temozolomide between surgery and the combined adjuvant treatment. RESULTS Twelve patients of median age 64.5 years (45-73) were included in the study. The median doses of temozolomide administered were respectively 265mg (225-300) for the early cycle; 130mg (110-150) for the concomitant treatment and 310mg (225-400) for the adjuvant one. Side effects during treatment were grade III lymphopenia, grade III neutropenia, fatigue and nausea/vomiting respectively in 4, 1, 7 and 5 patients. Progression-free survival and overall survival were respectively 90% and 91.7% at 6 months; 58.3 and 71.3% at 12 months; 31.1 and 71.3% at 18 months. CONCLUSION Early postsurgical temozolomide treatment prior to standard adjuvant therapy for poor prognosis glioblastoma patients in our small prospective series presents toxicity and survival similar to those published in the literature for the general population of glioblastoma. These encouraging results should be confirmed by a multicentric study comparing this regiment with the standard treatment.
Collapse
Affiliation(s)
- Elly Chaskis
- Hôpital Erasme, service de neurochirurgie, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - Sylvie Luce
- Hôpital Erasme, service d'oncologie médicale, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - Serge Goldman
- Hôpital Erasme, service de médecine nucléaire, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - Niloufar Sadeghi
- Hôpital Erasme, service de imagerie médicale, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - Christian Melot
- Hôpital Erasme, service de médecine d'urgence, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - Olivier De Witte
- Hôpital Erasme, service de neurochirurgie, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - Daniel Devriendt
- Institut Jules-Bordet, service de radiothérapie, 121, boulevard de Waterloo, 1000 Bruxelles, Belgique
| | - Florence Lefranc
- Hôpital Erasme, service de neurochirurgie, 808, route de Lennik, 1070 Bruxelles, Belgique.
| |
Collapse
|
3
|
Chaskis E, Minichini V, Luce S, Devriendt D, Goldman S, De Witte O, Sadeghi N, Lefranc F. [Contribution of temozolomide chemotherapy for intramedullary grade II spinal cord astrocytomas in adults: Our experience]. Neurochirurgie 2017; 63:297-301. [PMID: 28882604 DOI: 10.1016/j.neuchi.2017.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/08/2017] [Accepted: 05/20/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Grade II intramedullary astrocytomas are rare tumors. Despite a well-defined role of adjuvant temozolomide chemotherapy for brain gliomas, the contribution of this therapy for intramedullary gliomas is not yet clearly defined. METHOD We retrospectively analyzed the data of 5 adult patients treated with temozolomide between 2008 and 2015 for a grade II intramedullary astrocytoma with progression after surgery. RESULTS Five patients from 19 to 70 years of age (median, 37years) underwent a second surgery for the progression of a grade II intramedullary astrocytoma (median progression-free survival 26months [8-90]). All tumors remained grade II. Due to a second clinical or/and radiological tumor progression, the patients were treated with temozolomide after a 37months median progression-free survival (5-66). All patients received at minimum 12 cycles (mean 14 ± 5; range 12-24) of temozolomide (150-200mg/m2/day, 5days/28days). All patients were alive after a 10-year median follow-up after diagnosis (6-13). All patients were able to walk except one, who was previously in McCormick autonomy grade IV before chemotherapy. The McCormick autonomy rating after temozolomide was stable for 4 patients and improved for 1 patient. The treatment was delayed once for hematological toxicity. CONCLUSION Temozolomide stabilized all 5 patients without any major toxicity. Based on this experience that needs to be confirmed, we consider that temozolomide should be envisaged within the therapeutic arsenal for progressive intramedullary grade II astrocytomas.
Collapse
Affiliation(s)
- E Chaskis
- Services de neurochirurgie, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique
| | - V Minichini
- Services de neurochirurgie, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique
| | - S Luce
- Services d'oncologie médicale, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique
| | - D Devriendt
- Service de radiothérapie, institut Jules-Bordet, université libre de Bruxelles, 1000 Bruxelles, Belgique
| | - S Goldman
- Service de médecine nucléaire, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique
| | - O De Witte
- Services de neurochirurgie, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique
| | - N Sadeghi
- Service de radiologie, clinique de neurochirurgie oncologique, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique
| | - F Lefranc
- Services de neurochirurgie, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique.
| |
Collapse
|
4
|
Biau J, Dalloz P, Durando X, Hager MO, Ouédraogo ZG, Khalil T, Lemaire JJ, Chautard E, Verrelle P. [Elderly patients with glioblastoma: state of the art]. Bull Cancer 2015; 102:277-86. [PMID: 25732048 DOI: 10.1016/j.bulcan.2015.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/27/2015] [Indexed: 11/18/2022]
Abstract
The incidence of glioblastoma increases with age, with a median age, at diagnosis, of 65 years. Indeed, the optimization of standard of care of elderly glioblastoma patients in an aging population in Western countries becomes crucial. The age remains the main prognostic factor of glioblastoma. Survival among elderly patients is significantly less than among younger patients. The median survival of elderly glioblastoma patients is generally inferior to 6 months. More aggressive tumor behavior, less aggressive treatments, increased toxicity of therapies and more unfavorable clinical factors and comorbidities could explain a higher severity of the disease in the elderly. The balance between treatment efficacy and quality of life is a major focus because of the shorter life expectancy of patients. The standard of care of glioblastoma in elderly patients remains controversial. Large optimal resection, when achievable, should be preferred to biopsy. Survival is longer after adjuvant radiotherapy, either normofractionated over 6-weeks course or hypofractionated over 3-weeks course, for patients with good clinical status. Hypofractionation is often preferred because of shorter procedure. Chemotherapy alone with temozolomide can be proposed to patients with methylated MGMT promoter. A phase III randomized study, testing short-course adjuvant radiotherapy with or without temozolomide in elderly patients with good clinical status, is ongoing.
Collapse
Affiliation(s)
- Julian Biau
- Clermont université, EA7283 CREaT, centre Jean-Perrin, département de radiothérapie, 58, rue Montalembert, 63011 Clermont-Ferrand, France; Institut Curie, UMR CNRS 3347/Inserm U1021, équipe recombinaison, réparation et cancer, 91400 Paris-Orsay, France.
| | - Pierre Dalloz
- Centre Jean-Perrin, département d'oncologie médicale, 63011 Clermont-Ferrand, France
| | - Xavier Durando
- Inserm U501, centre d'investigation clinique, Clermont université, EA7283 CREaT, centre Jean-Perrin, département d'oncologie médicale, 63011 Clermont-Ferrand, France
| | - Marie-Odile Hager
- CHU, département d'oncogériatrie, centre Jean-Perrin, département d'oncologie médicale , 63011 Clermont-Ferrand, France
| | - Zangbéwendé Guy Ouédraogo
- Clermont université, EA7283 CREaT, centre Jean-Perrin, département de radiothérapie, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - Toufic Khalil
- Clermont université, CHU Gabriel-Montpied, service de neurochirurgie, EA7282, 63011 Clermont-Ferrand, France
| | - Jean-Jacques Lemaire
- Clermont université, CHU Gabriel-Montpied, service de neurochirurgie, EA7282, 63011 Clermont-Ferrand, France
| | - Emmanuel Chautard
- Clermont université, EA7283 CREaT, centre Jean-Perrin, département de radiothérapie, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - Pierre Verrelle
- Clermont université, EA7283 CREaT, centre Jean-Perrin, département de radiothérapie, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| |
Collapse
|