Abstract
Glioblastoma (GBM) is frequent in elderly patients, but their frailty provokes debate regarding optimal treatment in general, and the standard 6-week chemoradiation (CRT) in particular, although this is the mainstay for younger patients. All patients with newly diagnosed GBM and age ≥ 70 who were referred to our institution for 6-week CRT were reviewed from 2004 to 2018. MGMT status was not available for treatment decision at that time. The primary endpoint was overall survival (OS). Secondary outcomes were progression-free survival (PFS), early adverse neurological events without neurological progression ≤ 1 month after CRT and temozolomide hematologic toxicity assessed by CTCAE v5. 128 patients were included. The median age was 74.1 (IQR: 72–77). 15% of patients were ≥ 80 years. 62.5% and 37.5% of patients fulfilled the criteria for RPA class I–II and III–IV, respectively. 81% of patients received the entire CRT and 28% completed the maintenance temozolomide. With median follow-up of 11.7 months (IQR: 6.5–17.5), median OS was 11.7 months (CI 95%: 10–13 months). Median PFS was 9.5 months (CI 95%: 9–10.5 months). 8% of patients experienced grade ≥ 3 hematologic events. 52.5% of patients without neurological progression had early adverse neurological events. Post-operative neurological disabilities and age ≥ 80 were not associated with worsened outcomes. 6-week chemoradiation was feasible for “real-life” elderly patients diagnosed with glioblastoma, even in the case of post-operative neurological disabilities. Old does not necessarily mean worse.
Highlights
Glioblastoma (GBM) is frequent in elderly patients, but their frailty provokes debate regarding optimal treatment in general, and the standard 6-week chemoradiation (CRT) in particular, this is the mainstay for younger patients
The current therapeutics rely on surgical resection, radiotherapy (RT), chemotherapy (CT) and best supportive cares (BSC)[4]
We present the tolerance data and outcomes for all the elderly patients (≥ 70 years) who were referred to our institution for the standard 6-week chemoradiation
Summary
Glioblastoma (GBM) is frequent in elderly patients, but their frailty provokes debate regarding optimal treatment in general, and the standard 6-week chemoradiation (CRT) in particular, this is the mainstay for younger patients. Focusing on the elderly population (e.g. aged ≥ 70 years) with newly-diagnosed GBM is relevant for the following reasons: (i) the highest incidence rate is currently observed in patients aged 75–84 years[5]; (ii) neurological symptoms (following progression or treatment toxicities) may have dramatic consequences on independence and/or quality of life for such a frail p opulation[6,7]; (iii) the life expectancy is extremely poor but has increased in the last decade with the development of post-operative treatments[2]; (iv) GBM-specific geriatric scales of frailty are still lacking. A large phase 3 trial has shown the survival benefits of HFRT with TMZ versus HFRT alone for > 65 year-old and PS ≤ 2 patients[33] This type of regimen tends to be the current standard of care for elderly patients there are no prospective trials comparing it to the standard 6-week chemoradiation. Two ongoing phase 3 trials: EORTC-1709BTG (NCT03345095) (RT + TMZ and marizomib); and RT “dose painting” escalation + TMZ (SPECTRO-GLIO, NCT01507506)[34], have contributed to bringing to the fore the standard 6-week chemoradiation regimen for patients with no upper limit of age
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