Central Nervous System
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): Management of elderly patients with glioblastoma (GBM) has been investigated recently through four randomized trials comparing chemotherapy (CT) alone, radiotherapy (RT) alone, and combination treatments. These trials evaluated treatments for patients categorized by age alone. This retrospective study aims to evaluate the impact of Karnofsky performance status (KPS) in addition to age on the management and outcomes of elderly patients with GBM.
Materials/Methods: The National Cancer Database (NCDB) was queried for eligible patients: age ≥60 with histologically confirmed GBM between 2004 and 2015, and reported KPS. The following 4 age/KPS groups were created: ‘Age≥60/KPS<70’ (group 1), ‘Age 60-69/KPS≥70’ (group 2), ‘age 70-79/KPS≥70’ (group 3), ‘age≥80/KPS≥70’ (group 4). We also evaluated patients based on year of diagnosis: 2004-2012 (prior to publication of prospective elderly GBM trials), and 2013-2015. Overall survival (OS) was estimated using Kaplan-Meier and log-rank test methods. Univariate (UVA) and multivariable (MVA) modeling with Cox regression analysis was used to determine predictors of OS.
Results: A total of 30,530 patients met inclusion criteria. Median age at diagnosis was 69 (range 60-90), and median follow-up was 7.3 months (range 0-81.9). After surgery/biopsy, 3,936 were treated with RT alone, 775 with CT alone, 17,292 with both RT and CT (CT within 90 days of RT), and 8,537 had no/unknown adjuvant treatment. Median survivals were 5.2, 11.3, 6.3 and 3.7 months in groups 1, 2, 3 and 4, respectively (p <0.001). The proportions of patients receiving CT and RT were 65.5% in group 2, 53.7% in group 3, but only 48.2% in group 1 and 33.1% in group 4 (p<0.001). There was an increase in the use of combined CT and RT between 2004-2012 and 2013-2015 in patients in group 2 only (63.9% versus 66.9%, p<0.001). Use of hypofractionated RT increased between the period 2004-2012 and 2012-2015, especially in group 1 (25% versus 38%, respectively, p<0.001), and group 4 (28% versus 47%, respectively, p<0.001). On UVA, all patients did better with combined CT and RT, except those in group 1, who did better when treated with CT alone (1-year OS of 32.4% with CT and RT, versus 45.5% with CT alone, p<0.001). However, the addition of CT to RT was associated with better OS in all 4 groups (all p<0.01). Predictors of worse OS on MVA were similar in all 4 groups: white ethnicity, higher Charlson-Deyo comorbidity score, worse socioeconomic status, treatment in a community center, tumor multifocality, subtotal resection, non-IMRT use, and no adjuvant treatment (all p<0.01).
Conclusion: Based on this NCDB review, patients with GBM aged ≥60 with poor KPS have better survival following CT alone, whereas elderly patients with good KPS seem to fare best with combined CT and RT. These results suggest that functional status is an important prognostic factor that should be incorporated with chronological age for management decisions in the elderly GBM population
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