Abstract
Background: Treatment of elderly glioblastoma patients (EGP) is a challenge in neuro-oncology. The comprehensive geriatric assessment (CGA) is currently used to assess geriatric oncological patients with other types of tumors. We performed a large retrospective study to analyze its predictive role in EGP. Methods: Patients aged ≥65 years with histologically confirmed diagnosis of glioblastoma were enrolled. CGA included the following tests: the Cumulative Illness Rating Scale-Comorbidity and Severity Index, Activities of Daily Living, Instrumental Activities of Daily Living, the Mini Mental State Examination, and the Geriatric Depression Scale. Based on CGA results, each patient was categorized as fit, vulnerable, or frail. Results: We enrolled 113 patients. According to the CGA scores, 35% of patients were categorized as “fit”, 30% as “vulnerable”, and 35% as “frail” patients. Median overall survival was 16.5, 12.1, and 10.3 months in fit, vulnerable, and frail patients (p = 0.1), respectively. On multivariate analysis, the CGA score resulted an independent predictor of survival; indeed, vulnerable and frail patients had a hazard ratio of 1.5 and 2.2, respectively, compared to fit patients (p = 0.04). No association between CGA and progression-free survival (PFS) was demonstrated. Conclusions: The CGA score proved to be a significant predictor of mortality in EGP, and it could be a useful treatment decision tool.
Highlights
Glioblastoma is the most common primary malignant brain tumor in adults
For patients with a Karnofsky Performance Status (KPS) between 60 and 40, TMZ monotherapy was recommended in case of methylated methylguanine-DNA methyl-transferase (MGMT), while RT alone in presence of unmethylated MGMT, according to NOA-08 [8] and Nordic [17] trial results; in both trials, temozolomide was associated with survival advantages compared to radiotherapy in elderly patients with MGMT promoter methylation
Radical surgery was performed in 33% of patients; 80% of patients were treated with a radio-/chemotherapy combination (40% and 60% of patients received hypofractionated and standard radiation therapy, respectively) while single therapy was administered in 14% of cases; the median number of maintenance TMZ cycles was 3.9; best supportive care was performed in 6% of the patients
Summary
Glioblastoma is the most common primary malignant brain tumor in adults. Approximately half of glioblastoma cases develop in geriatric patients, and this proportion will increase with the aging of the population [1,2]. Radiation therapy, and chemotherapy, glioblastoma prognosis still remains poor with a median overall survival of about 15 months for patients aged less than or equal to 70 years and about 9 months for elderly glioblastoma patients [3,4]. In these patients, a more advanced age correlates with a worse prognosis [5]. Treatment of elderly glioblastoma patients (EGP) is a challenge in neuro-oncology. Methods: Patients aged ≥65 years with histologically confirmed diagnosis of glioblastoma were enrolled. According to the CGA scores, 35% of patients were categorized as “fit”, 30% as “vulnerable”, and 35% as “frail”
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