gms | German Medical Science

Objective: Glioblastomas are typical diseases of adulthood, but emerge most commonly in the elderly population. Despite multimodal therapy the average survival is only 18-24 months. The standard therapy (EORTC-protocol) consisting of resection and combined adjuvant radio-/chemotherapy was considered too stressful for elderly patients. The NOA-8 study showed that chemotherapy and radiotherapy alone lead to equal outcomes in overall survival (OS). However, the large neurooncological centres have treated most of the elderly patients with a KPS over 70 according to the EORTC-protocol. Therefore, the NOA-8 study does not represent the hospital routine. The aim of this study was to evaluate the effect of age on OS and progression free survival (PFS).

Methods: A total of 180 patients from 2013–2016 with a histopathological diagnosis of glioblastoma and primary resection were retrospectively studied. Most patients were intended to be treated with the EORTC-protocol. Clinical, radiological and neuropathological information was collected and statistically analysed. The follow-up included clinical and radiological assessment every 3 months following surgery. The study population was dichotomized into a non-geriatric (<65 years) and a geriatric (>64 years) group.

Results: The geriatric group consisted of 85 patients, the non-geriatric group of 95. Both groups showed a median pre- and post-operative KPS of 90. The median KPS 3 months postoperative was 90 in the non-geriatric and 80 in the geriatric group. A total of 65 patients (68%) of the non-geriatric group presented a local recurrence in one of the follow-up MRIs and 45 patients (53%) of the elderly group. The PFS in both groups did not significantly differ (p=0.2). Although the median OS was slightly in favour of the elderly group (24 vs. 21 months), statistical significance could not be reached (p=0.27).

Conclusion: The median pre- and postoperative KPS of 90 in both groups showed that the elderly and non-geriatric groups present with a similar general condition. However, the KPS 3 months postoperative pointed out that the elderly population has a slightly lower quality of life. The PFS and OS of the elderly and non-geriatric group did not significantly differ. Therefore, age does not seem to be a reliable factor for prognosis. Consequently, medical decision-making should not be limited by patient age. Further studies are needed to identify prognostic factors that enable robust therapeutic decision making.