Neuroonkologie bei älteren Patienten

Zusammenfassung

Fast jede Studie zur Behandlung von Patienten mit primären Hirntumoren zeigt das Alter als wichtigen prognostischen Faktor. Es existieren nur wenige Studien, die aufgrund der Einschlusskriterien oder der Anzahl rekrutierter Patienten Aussagen zum Therapieverlauf älterer Patienten erlauben. Eine Studie hat für Patienten, die älter als 70 Jahre sind eine Überlegenheit einer postoperativen Radiotherapie (28 × 1,8 Gy, 50,4 Gy) gegenüber einer rein supportiven Behandlung für das progressionsfreie und das Gesamtüberleben bei vergleichbarer Lebensqualität gezeigt. Außerdem wurde in einer Phase-II-Studie die Äquivalenz eines verkürzten Radiotherapieprotokolls (15 × 2,66 Gy, 40 Gy in 3 Wochen) gegenüber der am häufigsten verwendeten Fraktionierung (30 × 2 Gy, 60 Gy in 6 Wochen) bei über 60-jährigen Patienten demonstriert. Zu den nicht in adäquaten Studien überprüften Hypothesen für die Behandlung älterer Patienten mit Gliomen gehören Vorbehalte gegenüber dem Wert der Resektion bei älteren Patienten, gegenüber der als nebenwirkungsreich eingeschätzten (Standard-)Radiotherapie bei Älteren sowie gegenüber einer Chemotherapie. Es ist ungeklärt, ob Patienten mit Glioblastome, die älter als 65 Jahre sind, von einer Radiochemotherapie mit Temozolomid, der Standardtherapie bei jüngeren Patienten, profitieren. Aktuelle randomisierte Studien untersuchen kürzere gegenüber längeren Radiotherapieprotokollen, den Wert einer Monochemotherapie mit Temozolomid sowie die Therapie mit Temozolomid in Kombination mit einem verkürzten Radiotherapieprotokoll. Anstelle eines therapeutischen und wissenschaftlichen Nihilismus gibt es aktuell mehrere Studien, welche die spezifischen Probleme der Therapie älterer Patienten mit Glioblastom untersuchen.

Summary

Age has frequently been observed to be a major prognostic factor for progression-free and overall survival in glioblastoma patients. There are few studies including or adequately reflecting this patient population to qualify for definite answers in the elderly. A trial demonstrated radiotherapy (28 × 1.8 Gy, 50.4 Gy) to produce a longer progression-free and overall survival compared to best supportive care in 84 patients > 70 years at a comparable quality of life. Moreover, a phase-II trial reported equivalent survival when treating glioblastoma patients > 60 years with either a hypofractionated protocol (15 × 2.66 Gy, 40 Gy in 3 weeks) or conventional fractionation (30 × 2 Gy, 60 Gy in 6 weeks). Common clinicians’ reservations against a radical resection, against the standard radiotherapy as well as against chemotherapy in the elderly have not been adequately addressed in clinical trials to date. It remains unclear whether patients > 65 years benefit from the standard radiotherapy with temozolomide, which is standard of care for younger patients. Ongoing randomized trials compare abbreviated and standard radiotherapy protocols as well as the treatment with temozolomide in combination with a hypofractionated radiotherapy regimen. Instead of therapeutic and scientific nihilism several ongoing trials thus specifically address eminent problems in the care of elderly patients with glioblastoma.

Schlüsselwörter

MGMT - Temozolomid - Glioblastom - ältere Patienten

Keywords

MGMT - temozolomide - glioblastoma - elderly patients

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