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19.05.2017 | Clinical Study | Ausgabe 1/2017

Journal of Neuro-Oncology 1/2017

Glioblastoma multiforme (GBM) in the elderly: initial treatment strategy and overall survival

Zeitschrift:
Journal of Neuro-Oncology > Ausgabe 1/2017
Autoren:
Scott M. Glaser, Michael J. Dohopolski, Goundappa K. Balasubramani, John C. Flickinger, Sushil Beriwal
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s11060-017-2493-x) contains supplementary material, which is available to authorized users.
Data was presented in abstract form at the 2016 American Society for Radiation Oncology (ASTRO) annual meeting in Boston, MA.
The data used in the current study were derived from a de-identified National Cancer Data Base file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology used or the conclusions drawn from these data by the investigators. The interpretation and reporting of these data are the sole responsibility of the authors.

Abstract

The EORTC trial which solidified the role of external beam radiotherapy (EBRT) plus temozolomide (TMZ) in the management of GBM excluded patients over age 70. Randomized studies of elderly patients showed that hypofractionated EBRT (HFRT) alone or TMZ alone was at least equivalent to conventionally fractionated EBRT (CFRT) alone. We sought to investigate the practice patterns and survival in elderly patients with GBM. We identified patients age 65–90 in the National Cancer Data Base (NCDB) with histologically confirmed GBM from 1998 to 2012 and known chemotherapy and radiotherapy status. We analyzed factors predicting treatment with EBRT alone vs. EBRT plus concurrent single-agent chemotherapy (CRT) using multivariable logistic regression. Similarly, within the EBRT alone cohort we compared CFRT (54–65 Gy at 1.7–2.1 Gy/fraction) to HFRT (34–60 Gy at 2.5-5 Gy/fraction). Multivariable Cox proportional hazards model (MVA) with propensity score adjustment was used to compare survival. A total of 38,862 patients were included. Initial treatments for 1998 versus 2012 were: EBRT alone = 50 versus 10%; CRT = 6 versus 50%; chemo alone = 1.6% (70% single-agent) versus 3.2% (94% single-agent). Among EBRT alone patients, use of HFRT (compared to CFRT) increased from 13 to 41%. Numerous factors predictive for utilization of CRT over EBRT alone and for HFRT over CFRT were identified. Median survival and 1-year overall survival were higher in the CRT versus EBRT alone group at 8.6 months vs. 5.1 months and 36.0 versus 15.7% (p < 0.0005 by log-rank, multivariable HR 0.65 [95% CI = 0.61–0.68, p < 0.0005], multivariable HR with propensity adjustment 0.66 [95% CI = 0.63–0.70, p < 0.0005]). For elderly GBM patients in the United States, CRT is the most common initial treatment and appears to offer a survival advantage over EBRT alone. Adoption of hypofractionation has increased over time but continues to be low.

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Zusatzmaterial
Supplementary material 1 (PDF 182 KB)
11060_2017_2493_MOESM1_ESM.pdf
Supplementary material 2 (PDF 181 KB)
11060_2017_2493_MOESM2_ESM.pdf
Literatur
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