Abstract
Objective: Treatment of glioblastoma in elderly patients is particularly challenging due to their general condition and comorbidities. Treatment decisions are often based on chronological age. Frailty screening tests promise an assessment tool to stratify geriatric patients and identify those at risk for an unfavorable outcome. This study aims to evaluate the impact of age and frailty on the surgical outcome and overall survival in geriatric patients with glioblastoma.Methods: Data acquisition was conducted as a single-center retrospective analysis. From January 1st 2015, and December 31st 2019, 104 glioblastoma patients over 70 years of age were included in our study. Demographic data, tumor size, Karnofsky Performance Score (KPS), and Eastern Cooperative Oncology Group Performance Status (ECOG), as well as treatment modalities, were assessed. The Geriatric 8 health status screening tool (G8) and Groningen Frailty Index (GFI) were compiled pre-and postoperatively.Results: The mean patient age was 76.86 ± 4.11 years. Forty-nine (47%) patients were female, 55 (53%) male. Sixty-seven patients underwent microsurgical tumor resection, 37 received tumor biopsy alone. Mean G8 on admission was 12.4 ± 2.0, mean GFI 5.0 ± 2.5. In our cohort, frailty was independent of patient age, tumor size, or localization. Frailty, defined by G8 and GFI, is associated with shorter overall survival (G8: p = 0.0035; GFI: p = 0.0136) and higher numbers of surgical complications (G8: p = 0.0326; GFI: p = 0.0388). Frailer patients are more likely to receive best supportive care (p = 0.004). Nevertheless, frailty did not affect adjuvant treatment decision-making toward either single-use of chemo- or radiation therapy, stratified treatment, or concomitant therapy. The surgical decision on the extent of resection was not based on pre-operative frailty.Conclusion: In our study, frailty is a predictor of poorer surgical outcomes, post-operative complications, and impaired overall survival independent of chronological age. Frailty screening tests offer an additional assessment tool to stratify geriatric patients with glioblastoma and identify those at risk for a detrimental outcome and thus should be implemented in therapeutic decision making.
Highlights
Glioblastoma is the most common primary malignant brain tumor in adults with a dismal prognosis [1]
Older patients with glioblastoma have been underrepresented in clinical trials, as the average age of participants is 55 years compared to 65 years in populationbased studies [3]
Randomized data for the treatment of elderly patients with glioblastoma has been provided by trials conducted by the Scandinavian Neuro Oncology Network, the Neuro oncology Working Group of the German Cancer Society (NOA), as well as the Canadian Cancer Trials Group (CCTG) and the European Organization for Research and Treatment of Cancer (EORTC) [6,7,8]
Summary
Glioblastoma is the most common primary malignant brain tumor in adults with a dismal prognosis [1]. Given the poor overall prognosis, frequent coexisting conditions, and an increased risk of toxic effects from chemo- and radiotherapy on the aging brain, glioblastoma management in patients 65 years or older is exceedingly complex [5]. Evidence supports maximal safe surgical resection, the superiority of the concurrent radio-chemotherapy compared to TMZ or radiotherapy alone, and equivalency of short-course radiotherapy compared to longer treatments [8, 9]. These studies establish a new paradigm for treating elderly patients over 65 years. Frailty screening tests offer assessment tools to stratify geriatric patients and identify those at risk for a detrimental outcome, they are not commonly used in informing surgical decisions [12]
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