Zouaoui S.,Montpellier University |
Darlix A.,ICM |
Fabbro-Peray P.,Institut Universitaire de France |
Fabbro-Peray P.,University of Nimes |
And 18 more authors.
Neurosurgical Review | Year: 2014
The incidence of glioblastoma (GBM) has increased in patients aged 70 years or older, and will continue to grow. Elderly GBM patients have been excluded from most clinical trials; furthermore, optimal care management as well as benefit/risk ratio of GBM treatments are still being debated. This study describes oncological patterns of care, prognostic factors, and survival for patients ≥70 years in France. We identified patients over 70 with newly diagnosed and histologically confirmed GBM on data previously published by the French Brain Tumor DataBase. We included 265 patients. Neurological deficits and mental status disorders were the most frequent symptoms. The surgery consisted of resection (RSn=95) or biopsy (Bn=170); 98 patients did not have subsequent oncological treatment. After surgery, first-line treatment consisted of radiotherapy (RTn=76), chemotherapy (CTn=52), and concomitant radiochemotherapy (CRCn=39). The median age at diagnosis was 76, 74, and 73 years, respectively, for the untreated, B+RT and/or CT, RS±RT and/or CT groups. Median survival (in days, 95 % CI) with these main strategies, when analyzed according to surgical groups, was: B-CTn=41, 199[155-280]; B-CRCn=21, 318 [166-480]; B-RT n=37, 149[130-214]; RS-CT n=11, 245[211-na]; RS-CRC n=18, 372 [349-593]; RS-RT n=39, 269[218-343]. This population study for elderly GBM patients is one of the most important in Europe, and could be considered as a historical cohort to compare future treatments. Moreover, we can hypothesize that elderly patients (versus patients <70 years) are undertreated. Karnofsky performance status seems to be the most relevant clinical predictive factor, and RS and CRC have a positive impact on survival for elderly GBM patients in the general population, at least when feasible. © 2014 Springer-Verlag.
Bauchet L.,Montpellier University |
Mathieu-Daude H.,Groupe de Neuro Oncologie du Languedoc Roussillon |
Rigau V.,Montpellier University |
Fabbro M.,Groupe de Neuro Oncologie du Languedoc Roussillon |
And 28 more authors.
Neuro-Oncology | Year: 2010
This report, an audit requested by the French government, describes oncological patterns of care, prognostic factors, and survival for patients with newly diagnosed and histologically confirmed glioblastoma multiforme (GBM) in France. The French Brain Tumor DataBase, which is a national multidisciplinary (neurosurgeons, neuropathologists, radiotherapists, neurooncologists, epidemiologists, and biostatisticians) network, prospectively collected initial data for the cases of GBM in 2004, and a specific data card was used to retrospectively collect data on the management and follow-up care of these patients between January 1, 2004, and December 1, 2006. We recorded 952 cases of GBM (male/female ratio 1.6, median age 63.9 years, mean preoperative Karnofsky performance status [KPS] 79). Surgery consisted of resection (RS; n =541) and biopsy (n =411); 180 patients did not have subsequent oncological treatment. After surgery, first-line treatment (n =772) consisted of radiotherapy (RT) and temozolomide (TMZ) concomitant 1/2 adjuvant in 314 patients, RT alone in 236 patients, chemotherapy (CT) alone in 157 patients, and other treatment modalities in 65 patients. Median overall survival was 286 days (95% CI, 266-314) and was significantly affected by age, KPS, and tumor location. Median survival (days, 95% CI) associated with these main strategies, when analyzed by a surgical group, were as follows: RS + RT-TMZ (n=224): 476 (441-506), biopsy + RTTMZ (n=90): 329 (301-413), RS + RT (n=147): 363 (331-431), biopsy + RT (n=89): 178 (153-237), RS + CT (n=61): 245 (190-361), biopsy + CT (n=96): 244 (198-280), and biopsy only (n=118): 55 (46-71). This study illustrates the usefulness of a national brain tumor database. To our knowledge, this work is the largest report of recent GBM management in Europe. © The Author(s) 2010. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved.