Short-Course Radiation plus Temozolomide in Elderly Patients with Glioblastoma

被引：791

作者：

Perry, James R. ^{[1
]}

Laperriere, Normand ^{[2
]}

O'Callaghan, Christopher J. ^{[3
]}

Brandes, Alba A. ^{[9
]}

Menten, Johan ^{[11
]}

Phillips, Claire ^{[12
]}

Fay, Michael ^{[13
,14
]}

Nishikawa, Ryo ^{[16
]}

Cairncross, J. Gregory ^{[4
]}

Roa, Wilson ^{[5
]}

Osoba, David ^{[6
]}

Rossiter, John P. ^{[7
]}

Sahgal, Arjun ^{[1
]}

Hirte, Hal ^{[8
]}

Laigle-Donadey, Florence ^{[17
]}

Franceschi, Enrico ^{[9
]}

Chinot, Olivier ^{[18
]}

Golfinopoulos, Vassilis ^{[19
]}

Fariselli, Laura ^{[10
]}

Wick, Antje ^{[20
]}

Feuvret, Loic ^{[17
]}

Back, Michael ^{[15
]}

Tills, Michael ^{[21
]}

Winch, Chad ^{[3
]}

Baumert, Brigitta G. ^{[22
,23
]}

Wick, Wolfgang ^{[20
]}

Ding, Keyue ^{[3
]}

Mason, Warren P. ^{[2
]}

机构：

[1] Sunnybrook Hlth Sci Ctr, Odette Canc Ctr, A402,2075 Bayview Ave, Toronto, ON M4N 3M5, Canada

[2] Princess Margaret Canc Ctr, Toronto, ON, Canada

[3] Queens Univ, Canadian Canc Trials Grp, Kingston, ON, Canada

[4] Univ Calgary, Calgary, AB, Canada

[5] Univ Alberta, Edmonton, AB, Canada

[6] Qual Life Consulting, West Vancouver, BC, Canada

[7] Queens Univ, Kingston Gen Hosp, Kingston, ON, Canada

[8] Juravinski Canc Ctr, Hamilton, ON, Canada

[9] Azienda Unita Sanitaria Locale, Ist Ricovero & Cura Carattere Sci, Ist Sci Neurol, Bologna, Italy

[10] Fdn Ist Neurol Carlo Besta, Milan, Italy

[11] Univ Hosp Gasthuisberg, Leuven, Belgium

[12] Peter MacCallum Canc Ctr, Melbourne, Vic, Australia

[13] Univ Newcastle, Newcastle, NSW, Australia

[14] Univ Queensland, Brisbane, Qld, Australia

[15] Royal North Shore Hosp, Sydney, NSW, Australia

[16] Saitama Med Univ, Int Med Ctr, Saitama, Japan

[17] Hop La Pitie Salpetriere, Paris, France

[18] Aix Marseille Univ, CHU Timone, AP HM, Marseille, France

[19] European Org Res Treatment Canc, Brussels, Belgium

[20] Heidelberg Univ, Neurol Clin, Heidelberg, Germany

[21] Tauranga Hosp, Tauranga, New Zealand

[22] Maastricht Univ, Med Ctr, Maastricht, Netherlands

[23] Maastricht Univ, Sch Oncol & Dev Biol, Maastricht, Netherlands

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2017年 / 376卷 / 11期

关键词：

PROMOTER METHYLATION; RADIOTHERAPY; CHEMOTHERAPY; CONCOMITANT; MULTIFORME; PATTERNS; ADJUVANT; TUMORS; BRAIN; OLDER;

D O I：

10.1056/NEJMoa1611977

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Glioblastoma is associated with a poor prognosis in the elderly. Survival has been shown to increase among patients 70 years of age or younger when temozolomide chemotherapy is added to standard radiotherapy (60 Gy over a period of 6 weeks). In elderly patients, more convenient shorter courses of radiotherapy are commonly used, but the benefit of adding temozolomide to a shorter course of radiotherapy is unknown. METHODS We conducted a trial involving patients 65 years of age or older with newly diagnosed glioblastoma. Patients were randomly assigned to receive either radiotherapy alone (40 Gy in 15 fractions) or radiotherapy with concomitant and adjuvant temozolomide. RESULTS A total of 562 patients underwent randomization, 281 to each group. The median age was 73 years (range, 65 to 90). The median overall survival was longer with radiotherapy plus temozolomide than with radiotherapy alone (9.3 months vs. 7.6 months; hazard ratio for death, 0.67; 95% confidence interval [CI], 0.56 to 0.80; P< 0.001), as was the median progression-free survival (5.3 months vs. 3.9 months; hazard ratio for disease progression or death, 0.50; 95% CI, 0.41 to 0.60; P< 0.001). Among 165 patients with methylated O-6-methylguanine-DNA methyltransferase (MGMT) status, the median overall survival was 13.5 months with radiotherapy plus temozolomide and 7.7 months with radiotherapy alone (hazard ratio for death, 0.53; 95% CI, 0.38 to 0.73; P< 0.001). Among 189 patients with unmethylated MGMT status, the median overall survival was 10.0 months with radiotherapy plus temozolomide and 7.9 months with radiotherapy alone (hazard ratio for death, 0.75; 95% CI, 0.56 to 1.01; P = 0.055; P = 0.08 for interaction). Quality of life was similar in the two trial groups. CONCLUSIONS In elderly patients with glioblastoma, the addition of temozolomide to short-course radiotherapy resulted in longer survival than short-course radiotherapy alone. Funded by the Canadian Cancer Society Research Institute and others; ClinicalTrials. gov number, NCT00482677.)

引用

页码：1027 / 1037

页数：11

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