Real-world evaluation of the impact of radiotherapy and chemotherapy in elderly patients with glioblastoma based on age and performance status

Abstract

Background This retrospective study investigated the impact of Karnofsky performance status (KPS), in addition to age, on the management and outcomes of elderly patients with glioblastoma (GBM). Methods The National Cancer Database was queried between 2004–2015 for GBM patients with age ≥60. Three age groups were created: 60-69, 70-79, and ≥ 80 years old, and four age/KPS groups: ‘Age≥ 60/ KPS<70’ (group 1), ‘Age 60-69/KPS≥ 70’ (group 2), ‘age 70-79/KPS≥ 70’ (group 3), ‘age≥ 80/KPS≥ 70’ (group 4). Multivariable (MVA) modeling with Cox regression determined predictors of survival (OS), and estimated average treatment effects analysis was performed. Results A total of 48,540 patients with median age of 70 (range 60-90) at diagnosis, and median follow-up of 6.8 months (range 0-151) were included. Median survivals were 5.0, 15.2, 9.6 and 6.8 months in groups 1, 2, 3 and 4, respectively (p<0.001). On treatment effects analysis, all groups survived longer with combined chemotherapy (ChT) and radiation therapy (RT), except group 1 which survived longer with ChT alone (p<0.001). RT alone was associated with the worst OS in all groups (p<0.01). Across all groups, predictors of worse OS on MVA were older age, lower KPS, Caucasian, higher comorbidity score, worse socioeconomic status, community treatment, tumor multifocality, subtotal resection, and no adjuvant treatment (all p<0.01). Conclusions In elderly patients with newly diagnosed GBM, those with good KPS fared best with combined ChT and RT across all age groups. Performance status is a key prognostic factor that should be considered for management decisions in these patients.

Retrospective single-center study on elderly patients with glioblastoma between 2014 and 2018 evaluating the effect of age and performance status on survival

“…The WHO performance status was most strongly correlated while age was not independently correlated with the OS in our study. This is in accordance with the results of a recent retrospective study of Al Feghali et al 14 Their study is based on the National Cancer Database Query between 2004 and 2015 of GBM patients with median age of 70 years at diagnosis. In the study the median OS was 10.45 months, 5.78 months, and 3.52 months in age groups 60–69 years, 70–79 years, and >80 years, respectively.…”

Optimal managements of elderly patients with glioblastoma

“…Performance status is a key prognostic factor to be considered for management decisions in elderly patients with newly diagnosed glioblastoma ( 69 ). Retrospective studies identified predictors for poor OS of older age, lower KPS, white people, higher comorbidity score, worse socioeconomic status, community treatment, tumor multifocality, STR, aphasia after surgery, motor dysfunction after surgery and no adjuvant treatment ( 30 , 69–74 ).…”

Contemporary trends in management of uveal melanoma

“…The National Cancer Database (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons (ACoS) and the American Cancer Society. The NCDB collects data from more than 1,500 hospitals with ACoS-accredited cancer programs, accounting for 70% of all newly diagnosed cancers cases in the United States [ 15 - 17 ]. It includes data on tumor characteristics, patient demographics, and survival.…”