ED-02 * A SEER-MEDICARE DATA ANALYSIS OF ELDERLY GLIOBLASTOMA PATIENTS: TREATMENT PATTERNS, OUTCOMES AND COST

Abstract

BACKGROUND: Elderly GBM patients may not tolerate 6 weeks of radiotherapy (RT) and concurrent temozolomide (TMZ). Treatments utilizing hypofractionated RT and/or chemotherapy are alternatives. In this study, we use a population based database to determine treatment patterns, cost and outcomes. METHODS: The surveillance epidemiology and end-result (SEER) Medicare linked database was used to identify 3759 patients aged > 66 with GBM diagnosed between 1997 and 2009. Patients were stratified by initial treatment after surgery into 6 groups: no treatment, standard RT +/- TMZ, hypofractionated RT +/- TMZ or TMZ alone. RESULTS: Median age of 3759 patients was 74 years (range 66-97). Forty-eight percent (n = 1818) received standard RT without TMZ, 10% (n = 386) standard RT with TMZ. Twenty-nine percent (n = 1094) no treatment after diagnostic surgery. Ten percent (n = 390) received hypofractionated RT without TMZ. One percent (n = 43) hypofractionated RT with TMZ and less than 1% (n = 28) TMZ alone. Median survival for all patients was 6 months (range 0-121). Those that received no therapy had a median survival of 2 months (range 0-89). Patients that received standard RT +/- TMZ had median survivals of 11 (range 2-56) and 9 months (range 1-121) respectively (p = 0.01). Compared to the no therapy group, patients that had hypofractionated RT +/- TMZ or TMZ alone had improved median survivals of 3 months (range 1-29, AHR 0.48; 95% CI, 0.36-0.66), 4 months (range 0-33, AHR 0.55; 95% CI, 0.49-0.62) and 6 months (range 1-24, AHR 0.43; 95% CI, 0.29-0.62) respectively. Median post-surgery total treatment cost for patients receiving hypofractionated RT +/- TMZ or TMZ alone was $50,634, $27,284 and $39,708 respectively. CONCLUSIONS: Hypofractionated RT +/- TMZ or TMZ alone appear to improve survival in elderly GBM patients deemed not suitable for standard RT/TMZ. In some cases TMZ alone may be a more cost effective therapy with similar survival.