P17.27 * HIGH GRADE GLIOMAS IN ELDERLY PATIENTS: RESULTS OF SURGERY AND INFLUENCE ON KARNOFSKY'S PERFORMANCE STATUS

Abstract Background High-grade gliomas are among the most aggressive central nervous system primary tumors, with a high risk of recurrence and a poor prognosis. Re-operation, re-irradiation, chemotherapy are options in this setting. No-best therapy has been established. Bevacizumab was approved on the basis of two Phase 2 trials that evaluated its efficacy in patients with recurrent glioblastoma. Materials and methods We have retrospectively review data of patients with high-grade glioma treated at our institution that undergone radiological or histological progression after at least one systemic treatment for recurrent disease. Bevacizumab was administered alone or in combination with chemotherapy until disease progression or unacceptable toxicity. Bevacizumab regimen was analyzed to assess PFS and OS. Histological, molecular and clinical features of the entire cohort were collected. Results We reviewed data from 92 patients, treated from April 2009 to November 2019, with histologically confirmed diagnosis of high-grade gliomas and recurrent disease. A PFS of 55.2%, 22.9% and 9.6% was observed at 6, 12 and 24 months, respectively. Performance status, age at diagnosis (< 65 or > 65 ys.) and use of corticosteroids during bevacizumab therapy were strongly associated with PFS. The OS was 74.9% at 6 months, 31.7% at 12 months, 10.1% at 24 months. In our cohort, 51.1% were long-term responders (PFS > 6 months). Globally, bevacizumab treatment was well tolerated. Conclusion Our analysis confirms the efficacy of bevacizumab in recurrent high-grade glioma patients with an acceptable toxicity profile, in keeping with its known safety in the literature.

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Policies for reirradiation of recurrent high-grade gliomas: a survey among Italian radiation oncologists

Tumori Journal ◽

10.5301/tj.5000615 ◽

2018 ◽

Vol 104 (6) ◽

pp. 466-470

Author(s):

Carlo Furlan ◽

Stefano Arcangeli ◽

Michele Avanzo ◽

Maria A. Mirri ◽

Fernando Munoz ◽

...

Keyword(s):

Performance Status ◽

Collaborative Study ◽

Study Groups ◽

High Grade ◽

Private Institutions ◽

Online Questionnaire ◽

Radiation Oncologists ◽

Academic Hospitals ◽

The Central Nervous System ◽

High Grade Gliomas

Purpose: To assess the contribution of Italian radiation oncologists in the current management of recurrent high-grade gliomas (HGG), focusing on a reirradiation (reRT) approach. Methods: In 2015, the Reirradiation and the Central Nervous System Study Groups on behalf of the Italian Association of Radiation Oncology (AIRO) proposed a survey. All Italian radiation oncologists were individually invited to complete an online questionnaire regarding their clinical management of recurrent HGG, focusing on a reRT approach. Results: A total of 37 of 210 questionnaires were returned (18% of all centers): 16 (43%) from nonacademic hospitals, 14 (38%) from academic hospitals, 5 (13%) from private institutions, and 2 (6%) from hadron therapy centers. The majority of responding centers (59%) treated ≤5 cases per year. Performance status at the time of recurrence, along with a target diameter <5 cm and an interval from primary radiation ≥6 months, were the prevalent predictive factors considered for reRT. Sixty percent of reirradiated patients had already received a salvage therapy, either chemotherapy (40%) or reoperation (20%). The most common approach for reRT was fractionated stereotactic radiotherapy to a mean (photon) dose of 41.6 Gy. Conclusions: Although there were wide variations in the clinical practice of reRT across the 37 centers, the core activities were reasonably consistent. These findings provide a basis for encouraging a national collaborative study to develop, implement, and monitor the use of reRT in this challenging clinical setting.

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Prognostic Factors in Elderly Patients with High-grade Gliomas: A Retrospective Analysis of 24 Cases

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_576_17 ◽

2018 ◽

Vol 09 (03) ◽

pp. 312-316 ◽

Cited By ~ 1

Author(s):

Meenu Gupta ◽

Saurabh Bansal ◽

Deep Shankar Pruthi ◽

Manju Saini ◽

Nadia Shirazi ◽

...

Keyword(s):

Prognostic Factors ◽

Elderly Patients ◽

Retrospective Analysis ◽

Cox Regression ◽

Rank Test ◽

Karnofsky Performance Scale ◽

High Grade ◽

Concomitant Chemotherapy ◽

Cox Regression Analysis ◽

High Grade Gliomas

ABSTRACT Background and Objectives: Due to the aging of the population, diagnosis of high-grade gliomas (HGGs) in the elderly is becoming more common. The purpose of this study was to report our experience in 24 elderly patients with HGGs and evaluate the value of different prognostic factors. Design and Setting: Retrospective analysis of 24 elderly patients of ≥60 years with newly diagnosed HGGs, who were treated at our department between January 2009 and December 2012, was done. Patients and Methods: Age, gender, Karnofsky performance scale (KPS) score, extent of surgery, and use of temozolomide were evaluated using univariate and multivariate analyses. Survival was determined using the Kaplan–Meier method, and differences were compared using the log-rank test. Cox regression analysis was conducted to identify the independent prognostic factors. Results: The median overall survival of the patient cohort was 10 months. The 1- and 2-year survival rates were 45.8% and 16.6%, respectively. The analysis revealed that KPS score and use of concomitant chemotherapy were significant prognostic factors. Conclusion: The results of our analyses demonstrate that KPS score and use of concomitant chemotherapy yield encouraging outcomes in elderly patients with HGGs, validating the results published in research papers.

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The treatment of elderly patients with high-grade gliomas

Seminars in Oncology ◽

10.1053/j.seminoncol.2003.11.025 ◽

2003 ◽

Vol 30 ◽

pp. 58-62 ◽

Cited By ~ 30

Author(s):

Alba A Brandes ◽

Silvio Monfardini

Keyword(s):

Elderly Patients ◽

High Grade ◽

High Grade Gliomas

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EPID-14OUTCOMES IN ELDERLY PATIENTS WITH HIGH GRADE GLIOMAS

Neuro-Oncology ◽

10.1093/neuonc/nov213.14 ◽

2015 ◽

Vol 17 (suppl 5) ◽

pp. v81.1-v81

Author(s):

Lauren Gotterer ◽

Nehaw Sarmey ◽

Ming Chi ◽

Zhijian Chen ◽

Glen Stevens ◽

...

Keyword(s):

Elderly Patients ◽

High Grade ◽

High Grade Gliomas

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Safety and Efficacy of Hypofractionated Stereotactic Radiosurgery for High-Grade Gliomas at First Recurrence: A Single-Center Experience

10.21203/rs.3.rs-62212/v1 ◽

2020 ◽

Author(s):

Yun Guan ◽

Ji Xiong ◽

Mingyuan Pan ◽

Wenyin Shi ◽

Jing Li ◽

...

Keyword(s):

Planning Target Volume ◽

Performance Status ◽

Target Volume ◽

Salvage Treatment ◽

High Grade ◽

Who Grade ◽

Cyberknife Radiosurgery ◽

High Grade Gliomas ◽

First Recurrence ◽

Grade 3

Abstract Background: The optimal treatment for recurrent high-grade gliomas (rHGG) remains uncertain. This research aimed to investigate the efficacy and safety of CyberKnife radiosurgery as a salvage treatment for high-grade gliomas at first recurrence that within the radiation field.Methods: Between January 2016 and October 2019, rHGG patients treated with CyberKnife radiosurgery were retrospectively analyzed. The primary endpoint was OS, and secondary endpoints included progression-free survival (PFS) and toxicity. Toxicity was assessed using CTCAE 5.0. The prognostic value of key clinical features (age, performance status, planning target volume, dose, use of bevacizumab) were evaluated.Results: A total of 70 patients were included in the study. Forty patients were male and 30 were female. Forty-nine had an initial diagnosis Glioblastoma (GBM), and rest (21) were WHO Grade 3 Gliomas. The median planning target volume (PTV) was 16.68 cm3 (0.81–121.96 cm3). The median prescribed dose was 24 Gy (12-30 Gy) in 4 fractions (2-6 fractions). Median baseline Karnofsky Performance Status (KPS) is 70 (40-90). With a median follow-up of 12.1 months, the median overall survival after salvage treatment was 17.6 months (19.5 and 14.6 months for grade 3 and 4 gliomas; p = 0.039). No grade 3 or higher toxicities was recorded. Multivariate analysis showed concurrent bevacizumab with radiosurgery and KPS>70 were favorable prognostic factors for grade 4 patients.Conclusions: Salvage CyberKnife radiosurgery showed a favorable outcome and acceptable toxicity for rHGG. A prospective phase II study (NCT04197492) is ongoing to further investigate the value of HSRS in rHGG.

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NCOG-09. PREDICTIVE GERIATRIC FACTORS IN ELDERLY PATIENTS TREATED FOR IDH-MUTANT HIGH-GRADE GLIOMAS: A FRENCH POLA NETWORK STUDY

Neuro-Oncology ◽

10.1093/neuonc/noab196.600 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi153-vi153

Author(s):

Coline Montégut ◽

Jean-Sébastien Guillamo ◽

François Ducray ◽

Caroline Dehais ◽

Cohen-Jonathan Moyal Elisabeth ◽

...

Keyword(s):

Body Mass Index ◽

Elderly Patients ◽

Body Mass ◽

The Elderly ◽

High Grade ◽

Neuropsychological Disorders ◽

Comorbidity Index ◽

High Grade Gliomas ◽

And Biological Markers

Abstract We aimed to describe the characteristics, patterns of care and predictive geriatric factors of elderly patients with IDH-mutant (IDHm) high-grade gliomas (HGG) included in the French POLA network, dedicated to HGG (including 68% of IDHm HGG). For IDHm HGG patients over the age of 70 years, geriatric features were collected: G8 score items (appetite, weight loss, mobility, neuropsychological disorders, body mass index, medications, self-rated health, age), Activities and Instrumental Activities of Daily Living (ADL, IADL) scores, Charlson’s comorbidity Index (CCI) and biological markers. Out of the 1433 HGG patients included in the POLA Network, 119 (8.3%) occurred in patients ≥ 70 years. Among them, 39 presented with IDHm HGG. Of these 39 patients, estimated G8 score was ≤ 14/17 for 16 patients (64%), ADL score was < 6 for 33.3%, IADL score was < 4 for 47% and CCI was ≥ 5 for 72%. Regarding treatment feasibility, 6 of the 19 patients treated by temozolomide prematurely discontinued chemotherapy including 2 for toxicity and 4 for progression. Five of the 10 patients treated by PCV prematurely discontinued chemotherapy, all for toxicity. In multivariate analysis, loss of mobility (p=0.018; p=0.008), severe neuropsychological disorders (p=0.005; p=0.047), body mass index < 21 kg/m2 (p=0.002; p=0.006) and ADL score < 6 (p=0.002; p=0.01) were significantly predictive of poor PFS and OS. Then we generated a specific brain geriatric score including these four items with a sensibility, specificity and AUC for long term survivor (≥ 48 months) of 100%, 83% and 0.948 respectively. Using a cutoff of < 10/13, this score was significantly correlated to PFS and OS (p< 0.001 both). In conclusion, geriatric predictive factors may contribute to the elderly management improvement: the brain geriatric score must now be validated in a prospective independent cohort including IDHm and IDHwt elderly patients.

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Mitoxantrone is superior to doxorubicin in a multiagent weekly regimen for patients older than 60 with high-grade lymphoma: results of a BNLI randomized trial of PAdriaCEBO versus PMitCEBO

Blood ◽

10.1182/blood.v97.10.2991 ◽

2001 ◽

Vol 97 (10) ◽

pp. 2991-2997 ◽

Cited By ~ 25

Author(s):

Paul N. Mainwaring ◽

David Cunningham ◽

Walter Gregory ◽

Peter Hoskin ◽

Barry Hancock ◽

...

Keyword(s):

Overall Survival ◽

Elderly Patients ◽

Randomized Trial ◽

Combination Chemotherapy ◽

Chemotherapy Regimen ◽

Performance Status ◽

World Health ◽

High Grade ◽

Non Hodgkin Lymphoma ◽

Combination Chemotherapy Regimen

Abstract A prospective, multicenter, randomized trial was undertaken to compare the efficacy and toxicity of adriamycin with mitoxantrone within a 6-drug combination chemotherapy regimen for elderly patients (older than 60 years) with high-grade non-Hodgkin lymphoma (HGL) given for a minimum of 8 weeks. A total of 516 previously untreated patients aged older than 60 years were randomized to receive 1 of 2 anthracycline-containing regimens: adriamycin, 35 mg/m2intravenously (IV) on day 1 (n = 259), or mitoxantrone, 7 mg/m2 IV on day 1 (n = 257); with prednisolone, 50 mg orally on days 1 to 14; cyclophosphamide, 300 mg/m2 IV on day 1; etoposide, 150 mg/m2 IV on day 1; vincristine, 1.4 mg/m2 IV on day 8; and bleomycin, 10 mg/m2 IV on day 8. Each 2-week cycle was administered for a minimum of 8 weeks in the absence of progression. Forty-three patients were ineligible for analysis. The overall and complete remission rates were 78% and 60% for patients receiving PMitCEBO and 69% and 52% for patients receiving PAdriaCEBO (P = .05, P = .12, respectively). Overall survival was significantly better with PMitCEBO than PAdriaCEBO (P = .0067). However, relapse-free survival was not significantly different (P = .16). At 4 years, 28% of PAdriaCEBO patients and 50% of PMitCEBO patients were alive (P = .0001). Ann Arbor stage III/IV, World Health Organization performance status 2-4, and elevated lactate dehydrogenase negatively influenced overall survival from diagnosis. In conclusion, the PMitCEBO 8-week combination chemotherapy regimen offers high response rates, durable remissions, and acceptable toxicity in elderly patients with HGL.

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A Survival Score Based on Symptoms and Performance Status for Patients with High-grade Gliomas Receiving Radiochemotherapy

In Vivo ◽

10.21873/invivo.11114 ◽

2017 ◽

Vol 31 (4) ◽

pp. 689-693

Keyword(s):

Performance Status ◽

High Grade ◽

Survival Score ◽

High Grade Gliomas ◽

And Performance

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