Surgical and oncological score to estimate the survival benefit of resection and chemoradiotherapy in elderly (≥70 years) glioblastoma patients: A preliminary analysis

Abstract

Background Elderly patients with glioblastoma are perceived to face a poor prognosis with perceptions surrounding older age and a relative lack of randomized data contributing. This study evaluated survival prognosticators in elderly glioblastoma patients to more accurately guide their treatment. Materials and methods The records of 169 elderly (≥70 years) patients with a new diagnosis of glioblastoma who had undergone neurosurgical intervention were retrospectively examined for patient sex, age, performance status, comorbidities, MGMT promoter methylation, surgical intervention and chemoradiation regime. The adjusted survival impact of these factors was determined using Cox proportional hazards model and used to devise a two-stage scoring system to estimate patient survival at the stage of surgical (Elderly Glioblastoma Surgical Score, EGSS) and oncological management (Elderly Glioblastoma Oncological Score, EGOS). Results The median overall survival (mOS) of the cohort was 28.8 weeks. Gross-total and subtotal resection were associated with improved survival compared to biopsy alone (respective mOS 65.3 and 28.1 vs 15.7 weeks, p<0.001). Hypofractionated radiotherapy (40Gy in 15 fractions) with Temozolomide was non-inferior to the Stupp protocol, p=0.72. Exploratory subgroup analysis revealed a significant benefit of Temozolomide-based approaches in MGMT-methylated patients as well as a trend towards improved survival in MGMT-unmethylated patients. Our EGSS and EGOS scores successfully estimated survival in this retrospective cohort with 65% and 73% accuracy. Conclusions Where appropriate and safe, elderly glioblastoma patients may benefit from surgical resection and combined chemoradiotherapy with Temozolomide. The proposed EGSS and EGOS scores take into account important prognostic factors to help guide which patients should receive such treatment.

Surgical Management of Malignant Glioma in the Elderly

“…recently proposed both the Elderly Glioblastoma Surgical Score (EGSS) and the Elderly Glioblastoma Oncological Score (EGOS). Both were proven to be capable to estimate the survival of elderly glioblastoma patients, considering age, WHO performance status, surgical intervention and chemoradiotherapy ( 23 ).…”

“…Both sole hypofractionated radiotherapy and temozolomide chemotherapy are administered provides good results in elderly patients with poor performance status ( 11 , 22 ). Recent data, however, favors a combined radiotherapy as well, especially in MGMT-methylated patients, the method of radiation still matter of debate ( 23 ).…”