Survival outcome of elderly patients with Glioblastoma Multiforme in their seventy-fifth year or older treated with adjuvant therapy

Publication date: Available online 21 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): G. Harris, D. Jayamanne, H. Wheeler, C. Gzell, M. Kastelan, G. Schembri, D. Brazier, R. Cook, J. Parkinson, M. Khasraw, S. Louw, M. Back
AimTo assess the outcome of the most elderly cohort of patients diagnosed with Glioblastoma Multiforme (GBM) after management with Intensity Modulated Radiation Therapy (IMRT).MethodsPatients with GBM managed with IMRT from May 2007 to December 2015 were entered into a prospective database. Analysis was performed on patients diagnosed in or after their seventy-fifth year of life. The primary endpoint was median survival. Univariate and multivariate analysis were performed with respect to survival for age 74-80 vs >80 years, ECOG performance status of 0-1 vs 2-3, extent of resection, high dose of radiotherapy (60Gy) vs any hypofractionated schedule, MGMT methylation status, PTV volume, and the use of temozolomide (TMZ) vs no TMZ.ResultsOf the 108 patients, 35 were managed with best supportive care, 1 received TMZ alone, 40 received radiotherapy alone and 32 received combined radiotherapy and TMZ. IMRT was delivered with a hypofractionated technique (40Gy) in 58 patients and long course (60Gy) in 11 patients. The median age was 79 with 61.6% of patients being 74-80yrs and 38.4% >80yrs. There were 64 deaths on follow-up with median survival of 10 months (95%CI 7.1-11.9), projected 12-month survival of 35.6% and 24-month survival of 7.9%. On univariate evaluation, independent predictors of survival included younger age (p=0.02), performance status (p=0.014), extent of resection (p=0.002), and TMZ use (p<0.001). MGMT methylation status, RT dose and PTV volume showed no significant difference between the groups. Only chemotherapy use remained statistically significant (p=0.035) on multivariate analysis.ConclusionThe current literature underrepresents elderly patients over the age of 75 years with GBM. Despite elderly patients having a worse prognosis, this study suggests the presence of survival benefits with IMRT in selected patients that can be further extended with addition of TMZ. Further study of this cohort and understanding of appropriate selection criteria is warranted.

Teaser

The current literature underrepresents patients over the age of 75 years with GBM. In this study, we retrospectively analyzed the survival outcomes of patients in their seventy-fifth year or older with GBM treated at our centre. Even in the most elderly group of patients, intervention with maximum safe surgical resection and adjuvant IMRT and temozolomide can be delivered safely with possibly superior outcomes to best supportive care alone.


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