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Zanello M, Roux A, Ursu R, Peeters S, Bauchet L, Noel G, Guyotat J, Le Reste PJ, Faillot T, Litre F, Desse N, Emery E, Petit A, Peltier J, Voirin J, Caire F, Barat JL, Vignes JR, Menei P, Langlois O, Dezamis E, Carpentier A, Dam Hieu P, Metellus P, Pallud J. Recurrent glioblastomas in the elderly after maximal first-line treatment: does preserved overall condition warrant a maximal second-line treatment? J Neurooncol 2017; 135:285-297. [PMID: 28726173 DOI: 10.1007/s11060-017-2573-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/13/2017] [Indexed: 12/21/2022]
Abstract
A growing literature supports maximal safe resection followed by standard combined chemoradiotherapy (i.e. maximal first-line therapy) for selected elderly glioblastoma patients. To assess the prognostic factors from recurrence in elderly glioblastoma patients treated by maximal safe resection followed by standard combined chemoradiotherapy as first-line therapy. Multicentric retrospective analysis comparing the prognosis and optimal oncological management of recurrent glioblastomas between 660 adult patients aged of < 70 years (standard group) and 117 patients aged of ≥70 years (elderly group) harboring a supratentorial glioblastoma treated by maximal first-line therapy. From recurrence, both groups did not significantly differ regarding Karnofsky performance status (KPS) (p = 0.482). Oncological treatments from recurrence significantly differed: patients of the elderly group received less frequently oncological treatment from recurrence (p < 0.001), including surgical resection (p < 0.001), Bevacizumab therapy (p < 0.001), and second line chemotherapy other than Temozolomide (p < 0.001). In multivariate analysis, Age ≥70 years was not an independent predictor of overall survival from recurrence (p = 0.602), RTOG-RPA classes 5-6 (p = 0.050) and KPS at recurrence <70 (p < 0.001), available in all cases, were independent significant predictors of shorter overall survival from recurrence. Initial removal of ≥ 90% of enhancing tumor (p = 0.004), initial completion of the standard combined chemoradiotherapy (p = 0.007), oncological treatment from recurrence (p < 0.001), and particularly surgical resection (p < 0.001), Temozolomide (p = 0.046), and Bevacizumab therapy (p = 0.041) were all significant independent predictors of longer overall survival from recurrence. Elderly patients had substandard care from recurrence whereas age did not impact overall survival from recurrence contrary to KPS at recurrence <70. Treatment options from recurrence should include repeat surgery, second line chemotherapy and anti-angiogenic agents.
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Affiliation(s)
- Marc Zanello
- Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674, Paris Cedex 14, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Alexandre Roux
- Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674, Paris Cedex 14, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Renata Ursu
- Service de Neurologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Sophie Peeters
- Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674, Paris Cedex 14, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Luc Bauchet
- Department of Neurosurgery, University Hospital of Montpellier, Montpellier, France.,Inserm, U1051, Montpellier, France
| | - Georges Noel
- University Radiotherapy Department, Comprehensive Cancer Center Paul Strauss, Unicancer, Strasbourg, France.,Radiobiology Laboratory, EA 3440, Federation of Translationnal Medicine de Strasbourg (FMTS), Strasbourg University, Strasbourg, France
| | - Jacques Guyotat
- Service of Neurosurgery D, Lyon Civil Hospitals, Pierre Wertheimer Neurological and Neurosurgical Hospital, Lyon, France
| | | | - Thierry Faillot
- Department of Neurosurgery, APHP Beaujon Hospital, Clichy, France
| | - Fabien Litre
- Department of Neurosurgery, Maison Blanche Hospital, Reims University Hospital, Reims, France
| | - Nicolas Desse
- Department of Neurosurgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Evelyne Emery
- Departement of Neurosurgery, University Hospital of Caen, University of Lower Normandy, Caen, France
| | - Antoine Petit
- Department of Neurosurgery, University Hospital Jean Minjoz, Besancon, France
| | - Johann Peltier
- Department of Neurosurgery, Amiens University Hospital, Amiens, France
| | - Jimmy Voirin
- Department of Neurosurgery, Pasteur Hospital, Colmar, France
| | - François Caire
- Service de Neurochirurgie, CHU de Limoges, Limoges, France
| | - Jean-Luc Barat
- Department of Neurosurgery, Clairval Private Hospital, Marseille, France
| | | | - Philippe Menei
- Department of Neurosurgery, CHU d'Angers, Angers, France
| | - Olivier Langlois
- Department of Neurosurgery, Rouen University Hospital, Rouen, France
| | - Edouard Dezamis
- Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674, Paris Cedex 14, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie et Neurosciences, Inserm, U894, Paris, France
| | - Antoine Carpentier
- Service de Neurologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Phong Dam Hieu
- Department of Neurosurgery, University Medical Centre, Faculty of Medicine, University of Brest, Brest, France
| | - Philippe Metellus
- Department of Neurosurgery, Clairval Private Hospital, Marseille, France.,UMR911, CRO2, Aix-Marseille Université, Marseille, France
| | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674, Paris Cedex 14, France. .,Paris Descartes University, Sorbonne Paris Cité, Paris, France. .,Centre Psychiatrie et Neurosciences, Inserm, U894, Paris, France.
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