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Challenges to Treating Older Glioblastoma Patients: the Influence of Clinical and Tumour Characteristics on Survival Outcomes
- Source :
- Clinical oncology (Royal College of Radiologists (Great Britain)). 29(11)
- Publication Year :
- 2017
-
Abstract
- Aims There is now evidence to support giving single-agent chemotherapy, radiotherapy or hypofractionated concurrent chemoradiotherapy to older patients with glioblastoma (GBM). However, the clinical basis on which treatment decisions are made is under-researched and not standardised. This retrospective, multicentre study assessed whether pre-morbid characteristics or tumour imaging features could predict for overall survival in a cohort of older patients with GBM. Materials and methods Patients aged > 70 years, diagnosed with GBM at three neuro-oncology centres from 2010 to 2015 were retrospectively analysed. Demographic, clinical, radiological and treatment details were included in a multivariate model to examine for predictors of overall survival. Results In total, 339 patients were included with a median overall survival of 3.8 months. One and 2 year overall survival rates were 13% and 4%, respectively. The median age at diagnosis was 75 years. Pre-treatment characteristics predicting for overall survival included Eastern Cooperative Oncology Group performance status over 0 (performance status 1, hazard ratio 1.66, P = 0.042; performance status 2, hazard ratio 1.78, P = 0.031; performance status 3, hazard ratio 2.20, P = 0.008; performance status 4, hazard ratio 2.40, P = 0.021), radiological evidence of mass effect (hazard ratio 1.31, P = 0.049), multifocal tumours (hazard ratio 3.419, P = 0.013), presenting with seizures (hazard ratio 0.63, P = 0.008) and tumours confined to the cerebral hemisphere (hazard ratio 0.59, P = 0.048). Subtotal resection decreased risk of death by 37% ( P = 0.019) and total tumour resection by 44% ( P = 0.019). Palliative radiotherapy decreased risk of death by 41% ( P = 0.005), temozolomide alone by 60% ( P = 0.004) and radical chemoradiotherapy by 81% ( P Conclusion Clinical presentation, performance status and imaging characteristics are independent prognostic indicators of overall survival in older GBM patients, irrespective of age or treatment received.
- Subjects :
- Oncology
Male
medicine.medical_specialty
medicine.medical_treatment
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Humans
Radiology, Nuclear Medicine and imaging
Aged
Aged, 80 and over
Chemotherapy
Temozolomide
Performance status
business.industry
Hazard ratio
Prognosis
Surgery
Radiation therapy
Survival Rate
030220 oncology & carcinogenesis
Radiological weapon
Cohort
Female
business
Glioblastoma
030217 neurology & neurosurgery
Chemoradiotherapy
medicine.drug
Subjects
Details
- ISSN :
- 14332981
- Volume :
- 29
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Clinical oncology (Royal College of Radiologists (Great Britain))
- Accession number :
- edsair.doi.dedup.....f759d3ea331dfb4123ca5c8f7e9b185f