RTRB-14TREATMENT RECOMMENDATIONS FOR ELDERLY PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA LACK WORLDWIDE CONSENSUS

Abstract

This study explored the current worldwide management strategies for elderly patients with newly diagnosed glioblastoma. A web-based survey was distributed to 168 radiation oncologists (RO), neuro-oncologists (NO) and neurosurgeons (NS) from the United Council for Neurologic Subspecialties and CNS subcommittees of international cancer groups. Questions addressed the influence of molecular information, age, and comorbidities on treatment recommendations to determine whether management consensus exists. Respondents were allowed to choose more than one response. There were 58 (39%) respondents (50% NO, 3.5% NS and 50% RO) with 73% having > 10 years experience. 90% were academicians and 55% reportedly saw >50 patients with GBM annually. The most important factors influencing treatment decisions were KPS (92%), MGMT methylation status (72%), and comorbidity index (31%). Only 42% of respondents factor in age with 60% defining elderly as > 70 years-old. The most common recommendations for MGMT-methylated elderly patients with KPS > 70 were standard chemoRT (58%), temozolomide alone (28%), and short course RT (28%). The most common recommendations for MGMT-unmethylated patients with KPS > 70 were standard chemoRT (45%), short course RT (45%), and short course chemoRT (20%). Recommendations for patients with KPS < 50 were short course RT (52%), supportive care (50%), or TMZ alone (22%). Novo-TTF is or will soon be available at 74% of institutions. The majority (85%) of institutions do not have a clinical trial specifically for elderly patients with GBM, although 94% expressed interest in participating in such a trial. 98% of respondents are willing to randomize MGMT-unmethylated elderly patients to an arm without TMZ. Over 90% of respondents are willing to use short course RT as the standard RT for elderly patients, irrespective of MGMT methylation status. This study highlights that worldwide treatment recommendations for elderly patients with newly diagnosed GBM vary widely. Further randomized studies are warranted to elucidate the optimal treatment strategy.