Adjuvant Radiation in Older Patients With Glioblastoma: A Retrospective Single Institution Analysis.

Autor:	Lee JW; Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, United States., Kirkpatrick JP; Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, United States., McSherry F; Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, United States., Herndon JE 2nd; Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, United States., Lipp ES; Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, United States., Desjardins A; Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, United States., Randazzo DM; Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, United States., Friedman HS; Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, United States., Ashley DM; Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, United States., Peters KB; Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, United States., Johnson MO; Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in oncology [Front Oncol] 2021 Feb 25; Vol. 11, pp. 631618. Date of Electronic Publication: 2021 Feb 25 (Print Publication: 2021).
DOI:	10.3389/fonc.2021.631618
Abstrakt:	Objectives: Standard 6-week and hypofractionated 3-week courses of adjuvant radiation therapy (RT) are both options for older patients with glioblastoma (GBM), but deciding the optimal regimen can be challenging. This analysis explores clinical factors associated with selection of RT course, completion of RT, and outcomes following RT. Materials and Methods: This IRB-approved retrospective analysis identified patients ≥70 years old with GBM who initiated adjuvant RT at our institution between 2004 and 2016. We identified factors associated with standard or hypofractionated RT using the Cochran-Armitage trend test, estimated time-to-event endpoints using the Kaplan-Meier method, and found predictors of overall survival (OS) using Cox proportional hazards models. Results: Sixty-two patients with a median age of 74 (range 70-90) initiated adjuvant RT, with 43 (69%) receiving standard RT and 19 (31%) receiving hypofractionated RT. Selection of short-course RT was associated with older age (p = 0.04) and poor KPS (p = 0.03). Eight (13%) patients did not complete RT, primarily for hospice care due to worsening symptoms. After a median follow-up of 37 months, median OS was 12.3 months (95% CI 9.0-15.1). Increased age (p < 0.05), poor KPS (p < 0.0001), lack of MGMT methylation (p < 0.05), and lack of RT completion (p < 0.0001) were associated with worse OS on multivariate analysis. In this small cohort, GTV size and receipt of standard or hypofractionated RT were not associated with OS. Conclusions: In this cohort of older patients with GBM, age and KPS was associated with selection of short-course or standard RT. These regimens had similar OS, though a subset of patients experienced worsening symptoms during RT and discontinued treatment. Further investigation into predictors of RT completion and survival may help guide adjuvant therapies and supportive care for older patients. Competing Interests: JK reports grants from Varian Medical Systems, others from Clearsight RT Products, LLP, outside the submitted work. AD also receives research funding from Triphase Accelerator Corp., Orbus Therapeutics and Symphogen. AD serves as advisor/speaker/consultant for Istari Oncology and Orbus Therapeutics. AD holds stock/ownership interest with Istari Oncology. AD holds a letter of patent for Oncolytic Polio virus for the treatment of human tumors. HF received compensation for serving as Chief Medical Officer with Istari Oncology. HF holds stock/ownership interest with Istarti Oncology, Diverse Biotech, and Cancer Expert. HF serves as advisor/speaker/consultant for Cancer Expert. HF holds a letter of patent for Oncolytic Polio virus for the treatment of human tumors. KP receives research funding from Agios, BioMimetix, and Novocure. KP serves as advisor/speaker/consultant for Agios and Bayer. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Lee, Kirkpatrick, McSherry, Herndon, Lipp, Desjardins, Randazzo, Friedman, Ashley, Peters and Johnson.)
Databáze:	MEDLINE
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