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Glioblastoma Treatment in the Elderly in the Temozolomide Therapy Era

Published online by Cambridge University Press:  23 September 2014

Linda Coate ,
Mairéad G. McNamara ,
Zarnie Lwin ,
Derek MacFadden ,
Ahmed Al-Zahrani ,
Christine Massey ,
Cynthia Menard ,
Barbara Ann Millar ,
Arjun Sahgal  and
Normand Laperriere
...Show all authors
Linda Coate
Affiliation:
Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada Mid-Western Regional Hospital Limerick, Limerick, Ireland
Mairéad G. McNamara
Affiliation:
Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Zarnie Lwin
Affiliation:
Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada Department of Medical Oncology, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia
Derek MacFadden
Affiliation:
Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Ahmed Al-Zahrani
Affiliation:
Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada Department of Medical Oncology, King Faisal Cancer Center, Riyadh, Saudi Arabia
Christine Massey
Affiliation:
Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Cynthia Menard
Affiliation:
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Barbara Ann Millar
Affiliation:
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Arjun Sahgal
Affiliation:
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Normand Laperriere
Affiliation:
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Warren P. Mason*
Affiliation:
Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
*
*Pencer Brain Tumour Centre, Princess Margaret Cancer Centre, 610 University Avenue, Suite 18-717, Toronto, Ontario, M5G 2M9, Canada. Email: warren.mason@uhn.ca
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Abstract

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Background:

Optimal treatment of glioblastoma (GBM) in the elderly remains unclear. The impact of age on treatment planning, toxicity, and efficacy at a Canadian Cancer Centre was retrospectively reviewed.

Methods:

Glioblastoma patients treated consecutively between 2004 and 2008 were reviewed. Utilizing 70 years as the threshold for definition of an elderly patient, treatments and outcome were compared in younger and elderly populations.

Results:

Four hundred and twenty one patients were included in this analysis and median overall survival (OS) for the entire cohort was 9.8 months. 290 patients were aged <70 (median age 57, range 17–69) and 131 were aged ≥70 (median age 76, range 70–93). Patients ≥70 were more likely to receive best supportive care (BSC) and all patients >70 who were treated with radiotherapy received <60 Gy (P<0.001), except one. Patients aged >70 demonstrated inferior survival (one year OS 16% versus 54% for those <70, HR 3.46, P<0.001). In patients treated with BSC only, age had no impact on survival (median survival two months in both groups, HR 0.89, P=0.75). For those treated with higher doses of radiotherapy (>30 Gy to <60 Gy), one year survival was 19% versus 24% in patients aged >70 versus <70 (HR 1.47, P=0.02) respectively.

Conclusions:

In this retrospective single institution series, elderly patients were more likely to be treated with BSC or palliative doses of radiotherapy. Randomized phase III study results are required for guidance in treatment of this population of patients.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 3 , May 2014 , pp. 357 - 362
Copyright
Copyright © The Canadian Journal of Neurological 2014

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