P11.72.A Glioblastoma in elderly patients. Which is the best treatment option?

Background

Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumor in adults, and it is associated with a poor prognosis in the elderly. The current standard of care for newly diagnosed GBM is maximal surgical resection, followed by radiotherapy plus concomitant and adjuvant temozolomide (TMZ). In elderly patients with GBM, short-courses of radiotherapy with TMZ are used.

Material and Methods

We performed a single-center retrospective analysis of elderly GBM patients treated from 2013 to 2020. The primary endpoint was to evaluate progression free survival (PFS) and overall survival (OS) according to treatment received (TMZ and standard radiotherapy (60 Gy over a period of 6 weeks) vs TMZ and short-course radiotherapy (40 Gy in 15 fractions)). Secondary endpoints were analysis of population demographics and major toxicities associated to treatment.

Results

Twenty-two patients were identified. The median age was 72 years (range 65- 80), 18 (85.7%) patients were in ECOG-PS 0-1, 12 (57.1%) were males and all patients had undergone partial or complete resection surgery. Eleven (52.4%) patients received TMZ and standard radiotherapy and 10 (47.6%) patients received TMZ and short-course radiotherapy. Three (14.3%) patients had complete remission, 11 (52.4%) patients had partial response, 2 (9.5%) patients presented stable disease and 5 (23.8%) patients had disease progression. Median OS was 9 months (95% CI, 3.6 to 14.4) with TMZ with standard radiotherapy and 8 months (95% CI, 1.8 to 14.2) with TMZ and short-course radiotherapy (p=0.322). Median PFS was 5 months (95% CI, 2.8 to 7.2) with TMZ with standard radiotherapy and 6 months (95% CI, 3.1 to 8.9) with TMZ and short-course radiotherapy (p=0.944). Most common toxicities were hematological, with 5 (23.8%) patients presented thrombocytopenia grade 2 or higher. Five (23.8%) patients presented grade 3/4 toxicities (2 (9.5%) patients presented thrombocytopenia grade 4, 1 (4.8%) patient presented thrombocytopenia grade 3, and 2 (9.5%) patients presented anemia grade 3.

Conclusion

The prognosis of GBM remains poor besides standard therapy. TMZ and short-course radiotherapy should be an option in elderly patients due to its non-inferiority. Elderly patients should undergo a careful geriatric evaluation before starting treatment.

Deciduoid pleural mesothelioma--a rare entity in a young woman

Deciduoid Mesothelioma is a rare variant of epithelioid mesothelioma; it was initially thought that it only occurred in the peritoneum of young women and had nothing to do with asbestos exposure. However, since these early findings it has also been observed in the pleura and the pericardium, with possible association to asbestos. In general the prognosis is poor compared to epithelioid mesothelioma. 45 cases have been reported in the literature up to now, 22 of these were located in the pleural cavity. The authors describe a case of deciduoid pleural mesothelioma in a 40-year-old-woman who presented with right pleuritic chest pain, with no history of asbestos exposure, treated with chemotherapy followed by surgery and who died postoperatively.

Serum and pleural adenosine deaminase. Correlation with lymphocytic populations

This study attempts to correlate levels of ADA in tuberculous and neoplastic pleural exudates with the different immunologic cellular expressions that follow these clinical situations. Seventy-three patients with pleural effusion were studied in order to assess ADA activity (pleural and serum); in 25 of them, a study of delayed cellular immunity (pleural and sanguineous) was performed through B, CD3, CD4, and CD8 lymphocytic populations. The activity of ADA was determined, and the study of lymphocytic populations was made through the use of monoclonal antibodies. The data obtained showed the following: levels of ADA were significantly (p less than 0.0005) higher in the pleural fluid and the serum of tuberculous effusions compared to neoplastic effusions; percentages of CD3 and CD4 T-cells were significantly (p less than 0.05 and p less than 0.0005, respectively) greater in tuberculous effusions. The statistical study of the levels of ADA activity and the percentage of CD4 T-cells in pleural exudates produced a significant regression curve (r = 0.612 and p less than 0.0001) which showed a positive correlation between these two parameters. The pathogenic implications of these results suggest the possibility that ADA could be a new marker of cell-mediated immune activity.