gms | German Medical Science

Objective: The role of concomitant and adjuvant temozolomide in glioblastoma patients above the age of 65 years lacks evidence, due to exclusion from the EORTC trial published in 2005. Disregarding this, after 2005 at our centre all patients were considered for combined therapy. We retrospectively analysed the effect temozolomide focused on elderly subgroups. Because historical or conterminously controls are prone to selection bias, we performed matched pair analysis.

Methods: 343 patients with newly diagnosed glioblastoma between 1998 and 2010 treated at the university of Göttingen who had either radiation alone or concomitant and adjuvant radiochemotherapy were included in this analysis. Both treatment groups were analysed log-rank test. Subgroup analysis included patients above the age of 65, 70 and 75. Within these groups patients were matched for age, general condition and gross total resection, subtotal resection or biopsy only.

Results: Due to matched pair analysis for the radiation only and combined treatment group (n=310) the median age was 65.56 yrs (range 15.1 yrs to 86.6 yrs) and 65.53 yrs (range 22.4 yrs to 82.4 yrs), the median KPS before surgery was 70% (range 20 to 100%) and 70 % (range 30 to 90%) and the proportion of biopsy only patients was 41.9% and 26.6%, respectively. Patients with radiation only and radiochemotherapy revealed a median survival of 4.5 and 13.7 month, respectively (HR 0.465, p<0.0001). Survival benefit sustained considering patients over the age of 65 yrs (n=158, HR 0.278, p<0.0001), 70 yrs (n=106, HR 0.241, p<0.0001) and 75 yrs (n=44, HR 0.254, p=0.0002).

Conclusions: Until prospective control data for combined radio chemotherapy are available concomitant and adjuvant temozolomide should not be withhold to elderly patients.