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Management and Outcomes in the Oldest-Old Population with Glioblastoma

  • Fabio Y. Moraes (a1), Andrea Lo (a1), Erin R. Morgan (a2), Barbara-Ann Millar (a1), David B. Shultz (a1), Catherine Maurice (a2), Craig Harlos (a2), Paul Kongkham (a3), Mark Bernstein (a3), Gelareh Zadeh (a3), Normand Laperriere (a1), Warren Mason (a2) and Alejandro Berlin (a1)...

Abstract

Objectives: Glioblastoma is a lethal disease in the elderly population. We aimed to evaluate disease and treatment outcomes in the oldest-old patients. Methods: Patients >80 years old with histologically confirmed glioblastoma treated between 2004 and 2009 were identified. We included patients managed with best supportive care (BSC), temozolomide (TMZ) alone, radiotherapy (RT) alone, or concomitantly with TMZ (CRT). Survival outcomes were analyzed using the Kaplan–Meier method. Results: Ultimately, 48 patients were analyzed. Median age and Eastern Cooperative Oncology Group (ECOG) Performance Status were 82 years and 2, respectively. The median Age-Adjusted Charlson Index (AAC) was 6. Gross total and subtotal resections were performed in 16.7% and 18.8% of patients, respectively. Biopsy followed by RT alone was the treatment modality for 23/48 (47.9%), while 17/48 (35.4%) received surgery followed by RT alone or CRT. A total of 8 (16.7%) were managed with BSC after biopsy. Median overall survival (OS) and progression-free survival (PFS) were 4.1 (95% confidence interval [95% CI] 3.3-4.9) and 2.7 (95% CI 1.5-3.9) months, respectively. Improved median OS was observed in those treated with surgical resection followed by RT alone or CRT (7.1 months), compared to biopsy followed by RT alone (4.2 months) or BSC (2.0 months; p=0.002). Surgical resection, age85, and AAC<6 were associated with better OS (p=0.032, p=0.031, and p=0.02, respectively). Cause of death was neurological progression in 56% of cases. RT was well-tolerated. Conclusions: PFS and OS outcomes remain poor in the oldest-old patients (>80 years old). Younger age, lower AAC, surgical resection, and adjuvant treatment were associated with improved OS.

Prise en charge de patients d'âge très avancé atteints d'un glioblastome et évolution de leur état de santé. Objectifs: Chez les gens plus âgés, le glioblastome demeure une maladie mortelle. À cet égard, nous avons voulu évaluer l’évolution que peut connaître cette maladie et ses traitements en ce qui regarde des patients d’âge très avancé. Méthodes: Nous avons procédé à l’identification de patients de plus de 80 ans, traités entre 2004 et 2009, chez qui un examen histologique avait confirmé la présence d’un glioblastome. Nous avons notamment inclus des patients pris en charge au moyen des meilleurs soins de soutien disponibles ; au moyen du témozolomide seulement ; au moyen de la radiothérapie seulement ; ou au moyen de la radiothérapie et du témozolomide conjointement. Leurs chances de survie ont ensuite été analysées à l’aide de l’estimateur de Kaplan–Meier. Résultats: En bout de ligne, nous avons analysé les dossiers de 48 patients. Leur âge médian et leur score à l’échelle de l’Eastern Cooperative Oncology Group (ECOG) a été respectivement de 82 ans et de 2. L’âge médian obtenu en fonction de l’indice de comorbidité de Charlson (AAC) a été quant à lui de 6. Des résections totales ou partielles ont été effectuées respectivement chez 16,7 % et 18,8 % des patients. À la suite d’une biopsie, la radiothérapie s’est avérée l’unique modalité de traitement pour 23 patients (47,9 %) tandis que 17 d’entre eux (35,4 %) ont bénéficié d’une intervention chirurgicale suivie de la radiothérapie seulement ou de la radiothérapie jumelée au témozolomide. Enfin, seulement 8 patients (16,7 %) ont été pris en charge au moyen des meilleurs soins de soutien à la suite d’une biopsie. Le taux de survie médiane et le taux de survie sans progression de la maladie a été respectivement de 4,1 mois (IC 95 % ; 3,3-4,9) et de 2,7 mois (IC 95 % ; 1,5-3,9). Une amélioration du taux de survie médiane a été observée chez ceux et celles ayant bénéficié d’une résection suivie d’un traitement de radiothérapie seulement ou d’un tel traitement jumelé au témozolomide (7,1 mois). En comparaison, le taux de survie médiane d’un traitement basé uniquement sur la radiothérapie a été de 4,2 mois alors que les meilleurs soins de soutien ont procuré un taux de 2,0 mois (p=0,002). Des patients ayant subi une résection, âgés de 85 ans ou plus et ayant obtenu < 6 à l’indice de comorbidité de Charlson ont été par ailleurs associés à un meilleur taux de survie général (respectivement p=0,032, p=0,031 et p=0,02). Pour 56 % des patients étudiés, la cause de décès s’est révélée être une détérioration fatale de leurs fonctions neurologiques. Notons enfin que les traitements de radiothérapie ont été bien tolérés. Conclusions: Les taux de survie général et de survie sans progression de la maladie demeurent faibles chez les patients d’âge très avancé (plus de 80 ans). Cela dit, être moins âgé, avoir obtenu un score peu élevé à l’indice de comorbidité de Charlson, avoir subi une résection et bénéficié de traitements adjuvants sont tous des facteurs associés à un taux de survie général amélioré.

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Copyright

Corresponding author

Correspondence to: Alejandro Berlin, Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, 700 University Avenue, Toronto, Ontario M5G 2M9, Canada. Email: alejandro.berlin@rmp.uhn.ca

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Management and Outcomes in the Oldest-Old Population with Glioblastoma

  • Fabio Y. Moraes (a1), Andrea Lo (a1), Erin R. Morgan (a2), Barbara-Ann Millar (a1), David B. Shultz (a1), Catherine Maurice (a2), Craig Harlos (a2), Paul Kongkham (a3), Mark Bernstein (a3), Gelareh Zadeh (a3), Normand Laperriere (a1), Warren Mason (a2) and Alejandro Berlin (a1)...

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