Abstract
This study aimed to analyze the treatment and outcomes of older glioblastoma patients. Forty-four patients older than 70 years of age were referred to the Paul Strauss Center for chemotherapy and radiotherapy. The median age was 75.5 years old (range: 70–84), and the patients included 18 females and 26 males. The median Karnofsky index (KI) was 70%. The Charlson indices varied from 4 to 6. All of the patients underwent surgery. O6-methylguanine–DNA methyltransferase (MGMT) methylation status was determined in 25 patients. All of the patients received radiation therapy. Thirty-eight patients adhered to a hypofractionated radiation therapy schedule and six patients to a normofractionated schedule. Neoadjuvant, concomitant and adjuvant chemotherapy regimens were administered to 12, 35 and 20 patients, respectively. At the time of this analysis, 41 patients had died. The median time to relapse was 6.7 months. Twenty-nine patients relapsed, and 10 patients received chemotherapy upon relapse. The median overall survival (OS) was 7.2 months and the one- and two-year OS rates were 32% and 12%, respectively. In a multivariate analysis, only the Karnofsky index was a prognostic factor. Hypofractionated radiotherapy and chemotherapy with temozolomide are feasible and acceptably tolerated in older patients. However, relevant prognostic factors are needed to optimize treatment proposals.
Highlights
Glioblastoma (GBM) is among the most aggressive tumor types
Since older patients are often excluded from clinical trials, elderly patients are at risk of receiving inadequate treatment, which could explain the poor outcomes of these patients
Radiation therapy (RT) is recognized to improve survival in elderly patients with malignant gliomas when compared to the administration of only best supportive care [1]
Summary
Glioblastoma (GBM) is among the most aggressive tumor types. Its prognosis is associated with a rapidly progressive disease course and a generally fatal outcome. Half of all patients diagnosed with glioblastoma are older than 65 years of age. In this population, establishing a standard of care with which to prolong survival without degrading the patient’s quality of life remains very challenging. The randomized data do not demonstrate a benefit for the standard 6-week course of RT over a hypofractionated course of RT, given over 2 or 3 weeks [2,3] Other treatments such as chemotherapy alone have been favorably compared with radiotherapy alone [3,4,5]
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