Abstract
(1) Background: Studies in elderly patients over the age of 65 with glioblastoma have shown survival benefits of short-course radiation therapy with concurrent and adjuvant temozolomide, making it the standard of care adopted at Juravinski Cancer Center. Our study retrospectively examines patients with GBM aged ≥ 70 at the JCC treated with short-course radiation alone compared to those treated with short-course radiation and concurrent and adjuvant TMZ, to determine if there is a difference in outcomes based on performance status. (2) Methods: A retrospective chart review was conducted at JCC using patients diagnosed with GBM in 2014–2017 (treated with the old protocol of short-course RT alone) versus those diagnosed in 2017–2019 (treated with the new protocol of short-course radiation and TMZ). Patient demographics, treatments, outcomes, and baseline KPS were analyzed. (3) Results: No clear benefit and more neurologic decline post treatment were seen in patients with borderline performance status and subtotal resection who underwent concurrent treatment with temozolomide and radiation. The addition of temozolomide was most helpful in patients with good performance status and a gross total resection. Variable outcomes were seen in patients with mixed traits. (4) Conclusions: This study suggests that performance status and extent of resection are significant determinants of patient response to treatment. In the case of elderly patients with borderline performance status and GTR or those with good performance status and STR, also described as “mixed traits”, it may be beneficial to pursue single modality treatment, ideally based on MGMT promoter methylation status as opposed to bimodality treatment in order to maintain the best QOL.
Highlights
Glioblastoma (GBM) constitutes 54% of all gliomas and 16% of all new adult primary brain tumors diagnosed every year [1]
A total of 80 elderly patients treated at the Juravinski Cancer Center (JCC) for GBM were reviewed between 2014 and 2019
The treatment approach at the Juravinski Cancer Center for elderly patients with GBM shifted from short-course radiation alone to short-course radiation with concurrent and adjuvant TMZ
Summary
Glioblastoma (GBM) constitutes 54% of all gliomas and 16% of all new adult primary brain tumors diagnosed every year [1]. The median survival with GBM is less than two years, even with combined modality treatment [2]. The treatment of GBM included only surgical resection and radiation (6000 cGy in 30 fractions). Treatment of GBM with surgical gross total resection followed by concurrent and adjuvant radiation and temozolomide (TMZ) chemotherapy was established as the standard of care in patients aged 65 and younger [2]. In this population, overall survival has improved from 8 to 10 months to 12 to 14 months with the addition of TMZ [2]. Most research on GBM including the Stupp et al trial has been conducted using patients with an average age of 55, whereas the population-based median age of patients with GBM is 65 [1]
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