Glioblastoma in the elderly: treatment patterns and survival

Pretanvil, Jean-Aine; Salinas, Isaac Q; Piccioni, David

doi:10.2217/cns-2016-0023

Cited by 24 publications

(24 citation statements)

References 27 publications

(33 reference statements)

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“…We found that patients over the age of 60 years were less likely to receive adjuvant therapies than younger patinets. Similar trends have been observed in glioblastoma patients, in which age was the most significant predictor of the type of treatment received, with elderly patients less likely to receive adjuvant RT and CT [36,37]. As expected, the survival outcomes for younger patients were significantly better than those for older patients (median OS: 14.5 vs. 8.2 months; p < 0.001).…”

Section: Discussionsupporting

confidence: 78%

Assessment of treatment approach and survival outcomes in a modern cohort of patients with primary gliosarcoma using the national cancer database

Deng¹,

Cheung²,

Bai³

et al. 2018

Oncotarget

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Section: Discussionsupporting

confidence: 78%

Assessment of treatment approach and survival outcomes in a modern cohort of patients with primary gliosarcoma using the national cancer database

Deng¹,

Cheung²,

Bai³

et al. 2018

Oncotarget

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“…In our cohort, 56/123 (45.5%) showed an improved or unchanged postoperative KPSS with a median of 50%. Adjuvant treatment such as radiation therapy or chemotherapy is usually only offered to patients with a KPSS ≥ 70% [20,12]. Consequently, these patients are usually considered ineligible for adjuvant oncological treatment even after tumour resection.…”

Section: Discussionmentioning

confidence: 99%

Do Patients with a Poor Karnofsky Performance Status Scale Profit from Tumour Volume Reduction?

Barz¹,

J²,

Bette³

et al. 2020

Preprint

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Purpose: Median overall survival (OS) after diagnosis of glioblastoma (GBM) remains 15 months amongst patients receiving aggressive surgical resection, chemotherapy and irradiation. Treatment of patients with a poor preoperative Karnofsky Performance Status Scale (KPSS) is still controversial. Therefore, we retrospectively assessed the outcome after surgical treatment in patients with a KPSS of ≤ 60%.Methods: We retrospectively included patients with a de-novo glioblastoma WHO °IV and preoperative KPSS ≤ 60%, who underwent surgery at two neurosurgical centres between September 2006 and March 2016. We recorded pre- and postoperative tumour volume, pre- and postoperative KPSS, OS, age and MGMT promoter status.Results: 123 patients (58 females/65 males, mean age 67.4 ± 13.4 years) met the inclusion criteria. 75 of the 123 patients (61%) underwent surgical resection. 48/123 patients (39%) received a biopsy. The median preoperative and postoperative tumour volume of all patients was 33.0 ± 31.3 cm3 (IR 15.0–56.5cm3) and 3.1 ± 23.8 cm3 (IR 0.2–15.0 cm3), respectively. The median KPSS was 60% (range 20–60%) preoperatively and 50% (range 0–80%) postoperatively. The median OS was 123 ± 220 days (IR 52–395 days). Age (p<0.001, HR: 1.045 [95% CI 1.022–1.068]), postoperative tumour volume (p=0.02, HR: 1.016 [95% CI 1.002–1.029]) and MGMT promotor status (p=0.016, HR: 0.473 [95% CI 0.257–0.871]) were statistically significant in multivariate analysis.Conclusion: Patients with a preoperative KPSS of ≤ 60% benefit from low postoperative residual tumour volumes. Age and MGMT-methylation status were also significant prognostic parameters in this patient cohort.

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“…All therapeutic options remind on the importance of appropriately balancing quality of life with burden and benefits of therapies [ 55 – 62 , 63 •]. While some studies claim for a common definition for elderly [ 15 , 40 , 57 , 58 ] or describe and evaluate different treatment patterns retrospectively [ 42 , 59 , 60 ] or by pattern analysis [ 48 •, 57 ], some base their treatment recommendations on scoring age, KPS, and co-morbidity [ 55 , 57 ]. Most studies acknowledge the inherent diversity of elderly patients with its diversity between calendar age and biological age [ 60 – 62 , 63 •] while a few of them recommend the use of geriatric assessment to guide treatment assignment for elderly patients with GBM [ 56 , 60 , 63 ].…”

Section: Future Directionsmentioning

confidence: 99%

Guiding Treatment Choices for Elderly Patients with Glioblastoma by a Comprehensive Geriatric Assessment

et al. 2020

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Purpose of Review The incidence of glioblastoma multiforme (GBM) increases with age; more than half of newly diagnosed patients are older than 65 years. Due to age-dependent decreasing organ functions, comorbidities, functional decline, and increasing risk of social isolation, not all patients are able to tolerate standard therapy of GBM with 6 weeks of radiochemotherapy. Recent Findings A set of alleviated therapies, e.g., chemotherapy or radiotherapy alone, hypofractionated radiotherapies with different total doses and variable fractionation regimens as well as hypofractionated radiotherapy with concomitant and adjuvant chemotherapy, have been evaluated during the last years. However, clinicians are still unsure which therapy would fit best to a given patient. Recently, the predictive value of comprehensive geriatric assessment regarding tolerance of chemotherapy and prediction of early mortality has been validated for older GBM patients in a retrospective trial. Summary Thus, it appears that neuro-oncology is now ready for the prospective implementation of geriatric assessment to guide treatment planning for elderly GBM patients.

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Glioblastoma in the elderly: treatment patterns and survival

Abstract: OS was maximized in elderly patients who were able to get some surgical resection and undergo combined radiation and chemotherapy. OS survival in some elderly patients may be improved by more extensive therapy.

Cited by 24 publications

References 27 publications

Assessment of treatment approach and survival outcomes in a modern cohort of patients with primary gliosarcoma using the national cancer database

Assessment of treatment approach and survival outcomes in a modern cohort of patients with primary gliosarcoma using the national cancer database

Do Patients with a Poor Karnofsky Performance Status Scale Profit from Tumour Volume Reduction?

Guiding Treatment Choices for Elderly Patients with Glioblastoma by a Comprehensive Geriatric Assessment

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