Glioblastoma in patients over 70 years of age

Abstract

BackgroundGlioblastoma has in last 20 years seen the steady increase of incidence, which is most prominent in the group of older patients. These older than 70 years have significantly poorer prognosis than other patients and are considered a distinct group of glioblastoma patients. Modified prognostic factors are being used in these patients and this information is lately supplemented with the genetic and epigenetic information on tumour. The therapy is now often tailored accordingly. The aim of our study was to analyse the current treatment of the glioblastoma patients over 70 years of age to determine the impact of clinical prognostic factors.Patients and methodsAmong patients treated at the Institute of Oncology Ljubljana between 1997 and 2015, we found that 207 were older than 70 years. We analysed their survival, clinical prognostic factors (age, performance status) treatment modalities (extent of surgery, radiation dose, chemotherapy).ResultsMedian survival of patients older than 70 years was 5.3 months which was statistically significant inferior to the survival of younger patients (p < 0.001). The clinical prognostic factors that influenced survival the most were performance status (p < 0.001), extent of surgical resection (p < 0.001), addition of temozolomide (p < 0.001) and addition of radiotherapy (p = 0.006). Patients receiving concomitant radiochemotherapy with temozolomide followed by adjuvant temozolomide, had same median survival as patients receiving adjuvant temozolomide after completion of radiotherapy.ConclusionsThe increase of the number of older patients with glioblastoma corresponds to the increase in the life expectancy but in Slovenia also to the increased availability of diagnostic procedures. Clinical prognostic markers are helpful in decision on the aggressiveness of treatment. Radiotherapy and temozolomide have the biggest impact on survival, but the radiotherapy dose seems to be of secondary importance. In selected patients, chemotherapy alone might be sufficient to achieve an optimal effect. Patients that were fitter, had more aggressive surgery, and received temozolomide fared the best. The scheduling of the temozolomide seems to have limited impact on survival as in our study, there was no difference weather patients received temozolomide concomitant with radiotherapy or after the radiotherapy. Thus far, our findings corroborate the usefulness of recursive partitioning analysis (RPA) classes in clinical decisions.

Geriatric Neuro-Oncology in the Middle East: A Sultanate of Oman Experience

“…The increasing number of elderly patients with GBM corresponded to the increase in life expectancy. A study by Smrdel et al found that the average age of patients diagnosed with GBM was 73 years of age [25]. Likewise, in our cohort, the average age of patients diagnosed with GBM was 72.6 years of age.…”

Tumors: Brain

“…The isocitrate dehydrogenase (IDH) mutation is rare in tumors of patients aged 60 years or more (Louis et al 2016;Hartmann et al 2010); however, the distribution of MGMT promoter methylation is the same in older adults (Wick et al 2012). Median survival in recent large retrospective cohorts of older glioblastoma patients was between 5.3 and 6.2 months (Biau et al 2017;Harris et al 2017;Moroney et al 2017;Smrdel et al 2018). Only one cohort study found a median survival of 10 months in this patient population (Karsy et al 2018).…”

Baseline Serum C-Reactive Protein and Plasma Fibrinogen-Based Score in the Prediction of Survival in Glioblastoma

“…GBM represents 15.8% of all brain and CNS tumors (1). Established predictors for long-term survival in GBM include age at diagnosis, baseline Karnofsky Performance Status (KPS), and extent of resection (2)(3)(4)(5). Furthermore, mutations in biological markers are important features to create a reliable prediction of the survival prognosis in GB.…”