Glioblastoma multiforme (GBM) in the elderly: initial treatment strategy and overall survival

Journal of Neuro-oncology
Scott M GlaserSushil Beriwal

Abstract

The EORTC trial which solidified the role of external beam radiotherapy (EBRT) plus temozolomide (TMZ) in the management of GBM excluded patients over age 70. Randomized studies of elderly patients showed that hypofractionated EBRT (HFRT) alone or TMZ alone was at least equivalent to conventionally fractionated EBRT (CFRT) alone. We sought to investigate the practice patterns and survival in elderly patients with GBM. We identified patients age 65-90 in the National Cancer Data Base (NCDB) with histologically confirmed GBM from 1998 to 2012 and known chemotherapy and radiotherapy status. We analyzed factors predicting treatment with EBRT alone vs. EBRT plus concurrent single-agent chemotherapy (CRT) using multivariable logistic regression. Similarly, within the EBRT alone cohort we compared CFRT (54-65 Gy at 1.7-2.1 Gy/fraction) to HFRT (34-60 Gy at 2.5-5 Gy/fraction). Multivariable Cox proportional hazards model (MVA) with propensity score adjustment was used to compare survival. A total of 38,862 patients were included. Initial treatments for 1998 versus 2012 were: EBRT alone = 50 versus 10%; CRT = 6 versus 50%; chemo alone = 1.6% (70% single-agent) versus 3.2% (94% single-agent). Among EBRT alone patients, use of HFRT (compa...Continue Reading

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Citations

Feb 12, 2019·Neuro-oncology Practice·Emily V DresslerJohn L Villano
Jan 13, 2019·Clinical Cancer Research : an Official Journal of the American Association for Cancer Research·J Bryan IorgulescuArie Perry
Mar 19, 2021·Frontiers in Oncology·Jessica W LeeMargaret O Johnson
Nov 24, 2020·Neurosurgery Clinics of North America·Marco Conti NibaliMarco Riva

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