Treatment of newly diagnosed glioblastoma in the elderly

Glioblastoma (GBM) is a type of deadly brain tumor.
current standard treatment is to safely remove the tumor to the maximum extent possible, followed by simultaneous chemotherapy.
age is an important factor affecting the prognosmation of the disease, the older the age, the higher the risk of treatment-related toxic reactions and the shorter the survival time.
Catherine Hanna, of the Oncology Department at the University of Glasgow in the UK, summed up the costs and benefits associated with the best way to treat newly diagnosed glioblastoma in older people through online meta-analysis; the results were published online in March 2020 in Cochrane Database Syst Rev.
Methodology Researchers searched EED electronic databases including CENTRALRAL, MEDLINE, Embase, and database closures as of April 3, 2019;
included in the data from a randomized control study of glioblastoma in older adults, and, if the data were sufficient, used Stata software (version 15.1) for network meta-analysis (NMA) to compare treatment options.
as NMA data is insufficient, a pair of meta-analyses are performed in RevMan.
the evidence is graded by the GRADE method.
study included 12 randomized controlled trials (RCT) with 1,818 patients.
six RCTs were for older people newly diagnosed with glioblastoma, i.e. ≥65 years old or ≥70 years old;
7 trials were used for the overall survival analysis of meta-analysis, with interventions including 1 palliative support group, 4 RT40 groups with low-dose radiotherapy (40Gy total dose, 15 exposures) and 5 standard radiotherapy (60Gy total dose, divided into 3 RT60 group of 0 exposures; 3 tymoazine (TMZ) groups; 3 release, chemotherapy (CRT) group; 1 beval monoantitor combination release, chemotherapy (BEV_CRT) group; and 1 beva monoantigen combination radiotherapy (BEV_RT) group.
compared to palliative care, Meta's analysis shows that BEV_RT treatments other than those used to extend the patient's survival to some extent.
study found: (1) effects of different treatments on overall survival rates: Highly determinative evidence suggests that CRT can extend overall lifetime (OS) compared to RT40 (HR=0.67; 95% CI, 0.56-0.80).
low-level determination evidence suggests that CRT can extend the overall lifetime (HR=1.42; 95% CI, 1.01-1.98) compared to TMZ; crT plus BEV has little significant effect on the overall survival rate (HR=0.83; 95% CI, 0.48-1.44).
lack of data, it is not possible to compare the prognosm of different CRT radiotherapy programmes (60Gy/30 and 40Gy/15).
, CRT is higher than TMZ, RT, and palliative support when weighting treatments based on their impact on OS.
there was no significant difference between BEV-RT and palliative support treatment.
results suggest that interventions may improve the overall survival rate of patients.
(2) Effects of different treatments on quality of life (Quality of Life, QOL): Moderate determinative evidence suggests that QOL differences between the TMZ and RT groups were modest overall, except for discomfort due to communication disorders (which may be common in the RT group).
(3) Effects of different treatments on progressive survival rates: highly determinative evidence suggests that CRT prolongs progressive survival compared to RT40 (HR=0.50; 95% CI, 0.41-0.61); No progress time for the disease BEV_RT (HR=0.28; 95% CI, 0.17-0.46);
evidence for other treatments is low or very low.
(4) Serious Complications: Moderately determinative evidence suggests that TMZ may increase the risk of thrombosis at level 3 or above (RR=2.74; 95% CI, 1.26-5.94) and level 3 or more of median granulocyte reduction, lymphocyte reduction, and plate plate reduction risk compared to RT60.
, CRT may increase the risk of more than 3 levels of neutral granulocytes, white blood cell reduction, and plateplate reduction compared to RT, which is divided only normally.
addition of BEV to the CRT may increase the risk of thrombosis (RR=16.63; 95% CI, 1.00-275.42; medium determinative evidence).
conclusion, the authors conclude that CRT can extend the lifetime compared to RT for elderly people with strong self-care glioblastoma, and crat can extend the total lifetime compared to pure TMZ.
there was no significant difference in quality of life overall for patients treated with RT or TMZ.
use TMZ and BEV for systematic chemotherapy, which has a higher risk of severe blood cell reduction and thrombosis.
current evidence does not support the application of BEV to elderly patients.
new cancer treatment electric field (TTF) device may have a better application potential, but for the elderly population, there is also a need to affect the quality of life and tolerance of research.
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