Radiation combined with temozolomide contraindicated for young adults diagnosed with anaplastic glioma.

Pei Yang,Xiaoguang Qiu,Wenbin Li,Tao Jiang,Kun Yao,Wei Zhang,Xiaoxia Peng,Yinyan Wang,Shouwei Li,Chuanbao Zhang,Chenxing Wu,Jinquan Cai,Gan You

doi:10.18632/oncotarget.11756

Abstract

PurposeAge is a major prognostic factor for malignant gliomas. However, few studies have investigated the management of gliomas in young adults. We determined the role of survival and treatment in young adults with advanced gliomas in a large population from the Chinese Glioma Genome Atlas (CGGA).MethodsThis study included 726 adults (age ≥ 18) with histologically proven anaplastic glioma or glioblastoma multiforme (GBM). The overall and progression-free survival was determined in young (age < 50) and older groups (age ≥ 50).ResultsThe study included an older group (OP) of 264 patients and a younger group (YP) of 462patients. In the OP group with GBM and anaplastic glioma, patients treated with RT combined with temozolomide (TMZ) manifested significantly longer OS and PFS compared with patients assigned to RT alone (P < 0.05). In contrast, the YP group diagnosed with anaplastic glioma failed to show any survival advantage with RT plus TMZ compared with RT alone.ConclusionsWe observed no survival benefit in young adults (age < 50) with anaplastic glioma when treated with TMZ combined with RT. Our findings warrant further investigation of younger patients diagnosed with anaplastic glioma treated with radiotherapy plus TMZ chemotherapy.

Highlights

Malignant gliomas rank among the most prevalent primary intracranial neoplasms in adults [1], with an incidence of 80%. [2] Based on the the World Health Organization (WHO) criteria [3], grade IV glioblastoma multiforme (GBM) accounts for almost 65% of all the gliomas
The standard treatment for malignant gliomas consists of surgery, postoperative radiotherapy, combined with adjuvant TMZ chemotherapy
In the older group (OP) group, 131 (50 %) patients were treated with postoperative radiotherapy, and TMZ chemotherapy (RT+TMZ), 36 (14%) underwent postoperative radiotherapy alone (RT), 11 (4%) received postoperative TMZ chemotherapy alone (TMZ) and 25 (9%) were managed with supportive treatment

Summary

Introduction

Malignant gliomas rank among the most prevalent primary intracranial neoplasms in adults [1], with an incidence of 80%. [2] Based on the the World Health Organization (WHO) criteria [3], grade IV glioblastoma multiforme (GBM) accounts for almost 65% of all the gliomas. [4] Anaplastic glioma (grade III) is a diverse group of www.impactjournals.com/oncotarget malignancies comprising anaplastic astrocytoma (AA), anaplastic oligoastrocytoma (AOA) and anaplastic oligodendroglioma (AO) It is less frequently diagnosed and is associated with better prognosis compared with grade IV glioblastoma, despite shared molecular features and poor outcomes in the elderly.[5, 6]. [8] Cranial irradiation is associated with an increased risk of cognitive impairment.[9] Further, older patients are poorly tolerant to radiotherapy combined with TMZ.[10] Other studies suggest that older patients with a good performance status benefit from radiotherapy [11] and possibly from chemotherapy.[12] In addition, the ANOCEF Phase II results indicated that TMZ was safe in elderly patients with GBM and poor KPS.[13] few studies have focused on the treatment and survival of younger adults (age < 50 years)

Methods

Results

Conclusion