Evaluation of health outcomes in patients aged 70 years and above with glioblastoma multiforme in NHS Tayside between 2017-2020

Abstract

Abstract Aims The aim of this study is to evaluate health-related outcomes in patients aged 70 years and above diagnosed with glioblastoma multiforme (GBM) in NHS Tayside between 2017-2020. Objectives include identification of factors which influence the oncological treatment modalities pursued; disease progression/recurrence and outcomes within each treatment modality category. Method Medical databases were reviewed retrospectively to identify patients aged 70 years and above diagnosed with GBM in NHS Tayside, between 2017-2020. Analysed data identified patients' past medical history, symptoms and investigations preceding diagnosis; date of first brain imaging which demonstrated abnormality in-keeping with a likely diagnosis of GBM; factors influencing treatment modalities undertaken, molecular and genetic analysis of tumour samples; disease recurrence/progression, and date of death if applicable. Results 54 patients diagnosed with GBM. 13 patients were aged over 70 years. 8 males, 5 females. Commonest co-morbid conditions were hypertension and gout. 2/13 received best supportive care only, based on poor performance status and extensive disease burden. 9/13 underwent neurosurgery; 7 debulked; 2 biopsy only. 7 isocitrate dehydrogenase (IDH1) wild-type; 2 IDH classification not known. 3 MGMT methylated; 4 unmethylated; 2 MGMT classification not known.3/13 received temozolomide (TMZ) alone. 2 later received palliative radiotherapy (30Gy in 6 #) to control symptoms. 4/13 received 40Gy in 15 # with concurrent TMZ 4/13 received 60Gy in 30 # with concurrent TMZ. 5 received adjuvant TMZ following initial chemo-radiation: 3 after 40Gy and 2 after 60Gy. As of March 2021, 6/13 were alive, including all 4 who had received hypofractionated radiotherapy. 4 of these continue to demonstrate stable disease on most recent imaging. Conclusion Baseline fitness levels of patients were generally high, with few having significant co-morbidity pre-diagnosis. Prognosis and morbidity was significantly poorer in patients who did not undergo any form of radiotherapy. Patients who received hypofractionated radiotherapy demonstrated most favourable health-related outcomes, demonstrating longest survival and least evidence of disease recurrence/progression.Although the sample size for this study is small, it highlights the potential benefits of radiotherapy on survival, particularly hypofractionated courses such as 40Gy in 15 fractions in a real-world population, even during a global pandemic. It would be useful to prospectively follow-up elderly patients with GBM to assess outcomes and quality of life.