Abstract
Objective
The role of concurrent chemotherapy with radiation (RT) after resection/biopsy is not well established in elderly patients receiving standard or hypofractionated RT. We sought to identify patterns of early concurrent chemotherapy adoption and predictors of chemotherapy treatment selection in elderly glioblastoma (GBM) patients as well as association with overall survival (OS) in either radiation regimen.
Methods
Using the National Cancer Database (NCDB), we assessed clinical features and OS among elderly patients diagnosed with GBM from 1998 to 2012 in the USA. Patients were matched on gender, race, age, performance status, extent of resection, radiation scheme/fractionation, insurance, socioeconomic indicators, and facility type for OS and treatment utilization.
Results
In the NCDB, 17,005 patients with GBM were >70 years, received RT, and met inclusion criteria. Median age was 76, and median follow-up was 6.3 months. Use of concurrent chemotherapy increased during the study timeframe from 9.7 % in 1998 to 84.2 % in 2012. Concurrent chemotherapy was associated with male gender, white race, younger age, extensive surgery, standard fractionation, and treatment at academic/research centers (all p < 0.05). After propensity score matching, chemotherapy use remained associated with improved OS (HR = 0.52; 95 % CI, 0.44–0.61, p < 0.01) for cohorts receiving either standard or hypofractionated radiotherapy.
Conclusions
Concurrent chemotherapy was adopted early in the USA for elderly patients with GBM receiving both radiation fraction schemes. Concurrent chemotherapy was associated with improved OS for elderly patients with GBM, irrespective of radiotherapy schedule. Patient-specific variations in the use of chemotherapy exist that may be targeted to improve access to care.
from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2iHNmTG
via IFTTT
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου