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Journal of Neuro-Oncology

, Volume 129, Issue 3, pp 479–485 | Cite as

Age alone is not a predictor for survival in glioblastoma

  • Lucy GatelyEmail author
  • Anna Collins
  • Michael Murphy
  • Anthony Dowling
Clinical Study

Abstract

Over half of glioblastoma (GBM) cases are diagnosed in patients older than 65 years. Their median overall survival (OS) is 4–5 months, compared with 12–14 months in patients younger than 70 years. This retrospective audit aims to identify patterns of care and survival of patients diagnosed with GBM at a single institution in Melbourne, Australia. Consecutive histological diagnoses of adult primary GBM from January 2010 to December 2012 were retrospectively identified from medical records. Demographic, treatment and survival characteristics were recorded until death, with follow-up to January 1st 2015. Survival was estimated by Kaplan–Meier method. Planned, sub-group analyses were conducted using multivariate Cox proportional hazards model to identify differences between elderly and younger cohorts, as well as ECOG. 165 patients were identified (36 % aged ≥70 years). Those ≥70 years had a poorer performance status (ECOG 3–4: 27 vs 10 %, p = .005); poorer median OS (2.6 vs 11.5 months, p < .001); and were less likely to receive adjuvant treatment (no treatment: 40 vs 16 %, p < .001) compared with patients <70 years. Age was not a significant predictor of poorer os (HR 1.0; 0.99–1.03; p > .05), after adjusting for other clinical factors. Significant predictors of poorer os were poor performance status (p = .001), bilateral tumours (p = .04), biopsy only (p = .001), and no adjuvant treatment (p < .001). In patients diagnosed with GBM, those older than 70 years often present with poor performance status, are less likely to receive adjuvant treatment and have inferior os compared with younger patients. Treatment recommendations should be based on performance status/fitness, not age alone.

Keywords

Glioblastoma Elderly Survival Kaplan–Meier 

Notes

Acknowledgments

The authors would like to acknowledge the St Vincent’s Pathology department and Cancer Council Victoria for their assistance. Results were presented at the Medical Oncology Group of Australia Annual Scientific Meeting in 2015.

References

  1. 1.
    Iwamoto FM, Reiner AS, Panageas KS, Elkin EB, Abrey LE (2008) Patterns of care in elderly glioblastoma patients. Ann Neurol 64(6):628–634CrossRefPubMedGoogle Scholar
  2. 2.
    Graus F, Bruna J, Pardo J et al (2013) Patterns of care and outcome for patients with glioblastoma diagnosed during 2008–2010 in Spain. Neuro-Oncology 15(6):797–805CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Barnholtz-Sloan JS, Williams VL, Maldonado JL et al (2008) Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma. J Neurosurg 108(4):642–648CrossRefPubMedGoogle Scholar
  4. 4.
    Tanaka S, Meyer FB, Buckner JC et al (2013) Presentation, management, and outcome of newly diagnosed glioblastoma in elderly patients. J Neurosurg 118(4):786–798CrossRefPubMedGoogle Scholar
  5. 5.
    Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996CrossRefPubMedGoogle Scholar
  6. 6.
    Kita D, Ciernik IF, Vaccarella S et al (2009) Age as a predictive factor in glioblastomas: a population-based study. Neuroepidemiology 33(1):17–22CrossRefPubMedGoogle Scholar
  7. 7.
    Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5(6):649–655CrossRefPubMedGoogle Scholar
  8. 8.
    Perneger TV (1998) What’s wrong with bonferroni adjustments. BMJ 316(7139):1236–1238CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Filippini G, Falcone C, Boiardi A et al (2008) Prognostic factors for survival in 676 consecutive patients with newly diagnosed primary glioblastoma. Neuro-Oncology 10(1):79–87CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Chang-Halpenny CN, Yeh J, Lien WW (2015) Elderly patients with glioblastoma multiforme treated with concurrent temozolomide and standard-versus abbreviated-course radiotherapy. Perm J 19(1):15–20CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Almeida JP, Chaichana KL, Rincon-Torroella J, Quinones-Hinojosa A (2015) The value of extent of resection of glioblastomas: clinical evidence and current approach. Curr Neurol Neurosci Rep 15:517CrossRefPubMedGoogle Scholar
  12. 12.
    Chambless LB, Kistka HM, Parker SL, Hassam-Malani L, McGirt MJ, Thompson RC (2015) The relative value of postoperative versus preoperative Karnofsky Performance Scale scores as a predictor of survival after surgical resection of glioblastoma multiforme. J Neurooncol 121(2):359–364CrossRefPubMedGoogle Scholar
  13. 13.
    Laperriere N, Weller M, Stupp R et al (2013) Optimal management of elderly patients with glioblastoma. Cancer Treat Rev 39(4):350–357CrossRefPubMedGoogle Scholar
  14. 14.
    Keime-Guibert F, Chinot O, Taillandier L et al (2007) Radiotherapy for glioblastoma in the elderly. N Engl J Med 356(15):1527–1535CrossRefPubMedGoogle Scholar
  15. 15.
    Malmstrom A, Grønbert BH, Marosi C et al (2012) Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol 13(9):916–926CrossRefPubMedGoogle Scholar
  16. 16.
    Zouaoui S, Darlix A, Fabbro-Peray P et al (2014) Oncological patterns of care and outcomes for 265 elderly patients with newly diagnosed glioblastoma in France. Neurosurg Rev 37(3):415–423CrossRefPubMedGoogle Scholar
  17. 17.
    Perry J, O’Callaghan C, Ding K, et al (2016) A phase III randomised controlled trial of short-course radiotherapy with or without concomitant and adjuvant temozolomide in elderly patients with glioblastoma (NCIC CTG CE.6, EORTC 26062–22061, TROG 08.02, NCT00482677). J Clin Oncol (suppl; abstr LBA2)Google Scholar
  18. 18.
    Bauchet L, Zouaoui S, Darlix A et al (2014) Assessment and treatment relevance in elderly glioblastoma pateints. Neuro-Oncology 16(11):1459–1468CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Yovino S, Grossman SA (2011) Treatment of glioblastoma in “Elderly” patients. Curr Treat Options Oncol 12(3):253–262CrossRefPubMedGoogle Scholar
  20. 20.
    Curran WJ Jr, Scott CB, Horton J et al (1993) Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst 85(9):704–710CrossRefPubMedGoogle Scholar
  21. 21.
    Paravati AJ, Heron DE, Landsittel D et al (2011) Radiothearpy and temozolomide for newly diagnosed glioblastoma and anaplastic astrocytoma: validation of Radiation Therapy Oncology Group-recursive partitioning analysis in the IMRT and temozolomide era. J Neurooncol 104:339–349CrossRefPubMedGoogle Scholar
  22. 22.
    Wick W, Platten M, Meisner C et al (2012) Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Oncol 13:707–715CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Lucy Gately
    • 1
    Email author
  • Anna Collins
    • 2
  • Michael Murphy
    • 3
  • Anthony Dowling
    • 1
  1. 1.Department of OncologySt Vincent’s HospitalMelbourneAustralia
  2. 2.Centre for Palliative CareSt Vincent’s HospitalMelbourneAustralia
  3. 3.Department of NeurosurgerySt Vincent’s HospitalMelbourneAustralia

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