Highlights
- •We report a retrospective analysis of 151 elderly glioblastoma (GBM) patients.
- •Higher KPS, macroscopical total resection, radiotherapy and chemotherapy positively influence overall survival (OS).
- •Advanced age, seizure at onset, antiepileptic treatment and additional surgical resection did not influence OS.
- •In elderly fit patients extensive surgery and adjuvant treatment should be proposed.
- •Randomized controlled study is needed to develop treatment guidelines for elderly GBM patients.
Abstract
The appropriate treatment approach for elderly patients with glioblastoma multiforme
(GBM) is unclear, although different studies suggest survival benefit in fit patients
treated with radiotherapy and chemiotherapy after surgery. We performed a retrospective
analysis of 151 patients older than 65 years with GBM treated in 3 Lombardia Hospitals. In univariate regression analysis
higher KPS (p = 0.02), macroscopical total resection (p < 0.003), radiotherapy (p < 0.0001), chemotherapy (p < 0.0001) and second line chemotheraphy (p = 0.02) were of positive prognostic value. On the contrary older age (>70 years), presence of seizure at onset and additional resection after tumor recurrence
did not influence OS. Multivariate analysis revealed radiotherapy (HR 0.2 p < 0.0001) and extent of surgery (HR 0.3, p = 0,0063) as positive independent prognostic factors. Patients receiving radio-chemiotherapy
displayed more treatment-related toxicities with a slightly prolonged OS versus those
receiving hypofractionated radiotherapy. With the limits of a retrospective study,
our data suggest that in elderly fit patients extensive surgery should be considered,
moreover adjuvant treatments led to an increase in OS. Randomized controlled study
are needed to develop treatment guidelines for elderly GBM patients and to assess
whether the combination of post-surgical radio and chemiotherapy may be superior to
hypofractionated radiotherapy and chemiotherapy in fit patients.
Keywords
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Article info
Publication history
Published online: April 18, 2017
Accepted:
April 17,
2017
Received in revised form:
March 30,
2017
Received:
January 20,
2017
Footnotes
☆This research did not receive any specific grant from funding agencies in the public, commercial, or not-profit sectors.
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
