Survival outcome of elderly patients with Glioblastoma Multiforme in their seventy-fifth year or older treated with adjuvant therapy
Menée à partir de données portant sur 108 patients âgés de 74 ans ou plus et atteints d'un glioblastome multiforme traité entre 2007 et 2015 (âge médian : 79 ans), cette étude analyse la survie des patients après une radiothérapie avec modulation d'intensité en combinaison ou non avec le témozolomide
Aim : To assess the outcome of the most elderly cohort of patients diagnosed with Glioblastoma Multiforme (GBM) after management with Intensity Modulated Radiation Therapy (IMRT). Methods : Patients with GBM managed with IMRT from May 2007 to December 2015 were entered into a prospective database. Analysis was performed on patients diagnosed in or after their seventy-fifth year of life. The primary endpoint was median survival. Univariate and multivariate analysis were performed with respect to survival for age 74-80 vs >80 years, ECOG performance status of 0-1 vs 2-3, extent of resection, high dose of radiotherapy (60Gy) vs any hypofractionated schedule, MGMT methylation status, PTV volume, and the use of temozolomide (TMZ) vs no TMZ. Results : Of the 108 patients, 35 were managed with best supportive care, 1 received TMZ alone, 40 received radiotherapy alone and 32 received combined radiotherapy and TMZ. IMRT was delivered with a hypofractionated technique (40Gy) in 58 patients and long course (60Gy) in 11 patients. The median age was 79 with 61.6% of patients being 74-80yrs and 38.4% >80yrs. There were 64 deaths on follow-up with median survival of 10 months (95%CI 7.1-11.9), projected 12-month survival of 35.6% and 24-month survival of 7.9%. On univariate evaluation, independent predictors of survival included younger age (p=0.02), performance status (p=0.014), extent of resection (p=0.002), and TMZ use (p<0.001). MGMT methylation status, RT dose and PTV volume showed no significant difference between the groups. Only chemotherapy use remained statistically significant (p=0.035) on multivariate analysis. Conclusion : The current literature underrepresents elderly patients over the age of 75 years with GBM. Despite elderly patients having a worse prognosis, this study suggests the presence of survival benefits with IMRT in selected patients that can be further extended with addition of TMZ. Further study of this cohort and understanding of appropriate selection criteria is warranted.