INTRODUCTION While the current standard of care after maximal safe resection for glioblastoma (GBM) is concomitant radiation and chemotherapy, the ideal therapy for patients with poor performance status remains in question due to concerns about treatment tolerance. We sought to evaluate an alternative regimen, sequential radiation and chemotherapy, to assess its efficacy as a treatment option for poorly performing patients. METHODS We performed a retrospective analysis using the 2015 National Cancer Database in which the survival of patients with a KPS ≤ 70 who received sequential radiation and chemotherapy were compared to those who received radiation therapy alone. Survival outcomes were compared using Kaplan-Meier curves with log rank testing and Cox proportional hazard regression. RESULTS There were 84 patients analyzed in this study, all of whom had a KPS between 10 and 70. Of those analyzed, 73.8% received radiation therapy alone, and 26.2% received sequential radiation and chemotherapy. There was no difference in survival between the two treatment groups (p = 0.84). Patient age of 70 years or older (n = 31) was associated with decreased survival (HR 1.06 per year, p < 0.0001), regardless of KPS and a KPS of < 70 correlated with a near-significant trend toward worse survival (HR 1.63, p = 0.06). CONCLUSIONS Treatment with sequential radiation and chemotherapy in poorly performing patients is not associated with an advantage in survival outcome when compared to radiation alone in GBM patients with poor performance status.

中文翻译：

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序贯放化疗治疗恶性胶质母细胞瘤的疗效不佳。

简介虽然胶质母细胞瘤（GBM）的最大安全切除率后的当前护理标准是放疗和化疗，但由于对治疗耐受性的担忧，对于表现欠佳的患者的理想治疗仍存在疑问。我们试图评估一种替代方案，顺序放疗和化疗，以评估其作为治疗表现不佳的患者的治疗方案的功效。方法我们使用2015年国家癌症数据库进行了回顾性分析，将接受连续放疗和化疗的KPS≤70的患者与仅接受放疗的患者的生存期进行了比较。使用Kaplan-Meier曲线与对数秩检验和Cox比例风险回归对生存结果进行比较。结果本研究分析了84例患者，所有患者的KPS在10到70之间。在接受分析的患者中，有73.8％的患者单独接受放射治疗，有26.2％的患者接受连续放射和化疗。两个治疗组之间的生存率无差异（p = 0.84）。70岁或以上（n = 31）的患者年龄与生存率降低相关（每年HR 1.06，p <0.0001），与KPS无关，而KPS <70则表明生存率下降趋势接近显着（HR 1.63） ，p ＝ 0.06）。结论与表现较差的GBM患者单独接受放射治疗相比，表现较差的患者接受顺序放疗和化疗治疗与生存结局没有优势。两个治疗组之间的生存率无差异（p = 0.84）。70岁或以上（n = 31）的患者年龄与生存率降低相关（每年HR 1.06，p <0.0001），与KPS无关，而KPS <70则表明生存率下降趋势接近显着（HR 1.63） ，p ＝ 0.06）。结论与表现较差的GBM患者单独接受放射治疗相比，表现较差的患者接受顺序放疗和化疗治疗与生存结局没有优势。两个治疗组之间的生存率无差异（p = 0.84）。70岁或以上（n = 31）的患者年龄与生存率降低相关（每年HR 1.06，p <0.0001），与KPS无关，而KPS <70则表明生存率下降趋势接近显着（HR 1.63） ，p ＝ 0.06）。结论与表现较差的GBM患者单独接受放射治疗相比，表现较差的患者接受序贯放疗和化疗治疗与生存结局没有优势。p = 0.06）。结论与表现较差的GBM患者单独接受放射治疗相比，表现较差的患者接受顺序放疗和化疗治疗与生存结局没有优势。p = 0.06）。结论与表现较差的GBM患者单独接受放射治疗相比，表现较差的患者接受顺序放疗和化疗治疗与生存结局没有优势。