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Treatment recommendations for elderly patients with newly diagnosed glioblastoma lack worldwide consensus

  • Joshua D. Palmer
  • Deepak Bhamidipati
  • Minesh Mehta
  • Noelle L. Williams
  • Adam P. Dicker
  • Maria Werner-Wasik
  • Wenyin Shi
Clinical Study

Abstract

Background

Glioblastoma predominantly occurs in the 6th and 7th decades of life. The optimal treatment paradigm for elderly patients is not well established. We sampled current worldwide management strategies for elderly patients with newly diagnosed glioblastoma.

Methods

A web-based survey was developed and distributed to 168 radiation oncologists, neuro-oncologists and neurosurgeons identified through the United Council for Neurologic Subspecialties and the CNS committees for North American, European and Asian Organizations. Questions addressed treatment recommendations in order to determine whether management consensus exists in this patient subset.

Results

There were 68 (40%) respondents. Across respondents, the most important factors directing treatment were KPS (94%) and MGMT methylation status (71%). Only 37% of respondents strictly factor in age when making treatment recommendations with 59% defining elderly as greater than 70 years-old. The most common treatment recommendations for MGMT-methylated elderly patients with KPS > 70 were as follows: standard chemoRT (49%), short course chemoRT (39%), and temozolomide alone (30%). The most common treatment recommendations for MGMT-unmethylated patients with KPS > 70 were as follows: short course RT alone (51%), standard chemoRT (38%), and short course chemoRT (28%). Treatment recommendations for patients with KPS < 50 were short course RT alone (40%), best supportive care (57%), or TMZ alone (17%). Individuals practicing in North America were significantly more likely to recommend standard chemoradiation for patients compared to their European counterparts.

Conclusion

Worldwide treatment recommendations for elderly patients with newly diagnosed GBM vary widely. Further randomized studies are needed to elucidate the optimal treatment strategy for this subset of patients.

Keywords

Glioblastoma Elderly Treatment recommendations 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare no conflicts of interest.

Ethical approval

The study was approved by our institutional IRB.

Supplementary material

11060_2018_2969_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 21 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Joshua D. Palmer
    • 1
  • Deepak Bhamidipati
    • 2
  • Minesh Mehta
    • 3
  • Noelle L. Williams
    • 4
  • Adam P. Dicker
    • 2
  • Maria Werner-Wasik
    • 2
  • Wenyin Shi
    • 2
  1. 1.Department of Radiation OncologyThe James Cancer Hospital and Solove Research Institute at The Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Department of Radiation OncologySidney Kimmel Medical College and Cancer Center at Thomas Jefferson UniversityPhiladelphiaUSA
  3. 3.Department of Radiation OncologyMiami Cancer InstituteMiamiUSA
  4. 4.Southeast Radiation Oncology GroupLevine Cancer Institute at Atrium HealthCharlotteUSA

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