Age impacts the pattern of care for elderly patients with rectal cancer.

PURPOSE: This study analyzed the current approaches for rectal cancer treatment in elderly patients. METHODS: We retrospectively studied 240 rectal cancer patients who had undergone radiotherapy from 2000 to 2008. The ages of the patients ranged from 65 and 75 years (group A, n = 127) and older than 75 years (group B, n = 113). The distribution of the Charlson comorbidity index was similar between the two groups, but the ECOG performance status (PS) differed between the groups (66 % of the patients of group A were PS 0, and 40 % were PS 0 in group B (p < 0.0001)). The tumor stages were comparable between groups. RESULTS: The median age of the patients was 74.3 years (range 65-90.6). Treatment was discussed during a multidisciplinary cancer team meeting before treatment for 55 % of the cases in group A and 73 % of the cases in group B (p < 0.001), and treatment proposals were in accordance with guidelines in 96 % of the cases in group A and 76 % of the cases in group B (p < 0.001). Group B patients received slightly less concurrent chemotherapy (35 vs. 30 % for group A; p = 0.54), more hypofractionated radiotherapy (41 vs. 54 % for group A; p = 0.064), less surgery (92 vs. 80 % for group A; p = 0.014), and less adjuvant chemotherapy (34 vs. 10 % for group A; p < 0.001). Finally, 80 % of the patients in group A and 60 % of the patients in group B received treatment in accordance with guidelines (p = 0.007) and in the logistic regression model. Non-metastatic patients who were aged below 75 years were predicted for conformal management (HR = 0.323; 95 % CI = 0.152-0.684) irrespective of their performance status, comorbidity, or disease stage. CONCLUSIONS: Treatment proposals and administered therapy differed according to age.

Outcomes in newly diagnosed elderly glioblastoma patients after concomitant temozolomide administration and hypofractionated radiotherapy.

This study aimed to analyze the treatment and outcomes of older glioblastoma patients. Forty-four patients older than 70 years of age were referred to the Paul Strauss Center for chemotherapy and radiotherapy. The median age was 75.5 years old (range: 70-84), and the patients included 18 females and 26 males. The median Karnofsky index (KI) was 70%. The Charlson indices varied from 4 to 6. All of the patients underwent surgery. O6-methylguanine-DNA methyltransferase (MGMT) methylation status was determined in 25 patients. All of the patients received radiation therapy. Thirty-eight patients adhered to a hypofractionated radiation therapy schedule and six patients to a normofractionated schedule. Neoadjuvant, concomitant and adjuvant chemotherapy regimens were administered to 12, 35 and 20 patients, respectively. At the time of this analysis, 41 patients had died. The median time to relapse was 6.7 months. Twenty-nine patients relapsed, and 10 patients received chemotherapy upon relapse. The median overall survival (OS) was 7.2 months and the one- and two-year OS rates were 32% and 12%, respectively. In a multivariate analysis, only the Karnofsky index was a prognostic factor. Hypofractionated radiotherapy and chemotherapy with temozolomide are feasible and acceptably tolerated in older patients. However, relevant prognostic factors are needed to optimize treatment proposals.

Peripheral B cell abnormalities in patients with systemic lupus erythematosus in quiescent phase: decreased memory B cells and membrane CD19 expression.

B lymphocytes from patients with systemic lupus erythematosus (SLE) are hyperactive and produce autoantibodies. Several B cell phenotype characteristics such as the expansion of activated populations, and of a newly identified memory compartment have already been reported. These results are not easy to interpret because of the clinical heterogeneity of SLE, as well as the difficulties to establish homogeneous and well defined groups taking in consideration the activity of the disease and the various therapies. However, although many mediators and mechanisms can contribute to the clinical presentation and subsequent progression of individuals with SLE, several data suggest that some intrinsic B cells abnormalities may be central to the disease process. In this view, we have analysed the phenotype of B cells from 18 patients with quiescent diseases (mean SLEDAI score below 2) and from 11 healthy controls. B cell surface marker expression was determined by flow cytometry. We analysed the main B cell sub-populations. We demonstrate the persistence of plasmocyte-differentiated and -activated B cells even in quiescent patients. However, quiescent patients display a decrease in memory B cells that could reflect the control of their disease. Above all, we describe a lower membrane expression of the CD19 protein on all B cells in every patient compared to controls. This lower CD19 expression is associated with reduced CD45 levels. It is not associated with an evident gene expression alteration and in vitro stimulation restores a control phenotype. These findings suggest certain mechanisms of lupus development.