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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Treatment of very elderly glioblastoma patients – whom to treat

Behandlung sehr alter Glioblastompatienten – wen man behandeln sollte

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  • presenting/speaker Peter Baumgarten - Universitätsklinikum Frankfurt am Main, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Georg Prange - Universitätsklinikum Frankfurt am Main, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Daniel Dubinski - Universitätsklinikum Frankfurt am Main, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Marie-Thérèse Forster - Universitätsklinikum Frankfurt am Main, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Patrick N. Harter - Johann Wolfgang Goethe-Universität Frankfurt am Main, Edinger Institut, Neuropathologie, Frankfurt am Main, Deutschland
  • Marlies Wagner - Universitätsklinikum Frankfurt am Main, Neuroradiologie, Frankfurt am Main, Deutschland
  • Joachim Steinbach - Universitätsklinikum Frankfurt am Main, Neuroonkologie, Frankfurt am Main, Deutschland
  • Volker Seifert - Universitätsklinikum Frankfurt am Main, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Christian Senft - Universitätsklinikum Frankfurt am Main, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV004

doi: 10.3205/20dgnc004, urn:nbn:de:0183-20dgnc0046

Published: June 26, 2020

© 2020 Baumgarten et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: The prognosis of patients ≥75 years of age suffering from glioblastoma is poor. Novel therapies are usually reserved for patients ≤65 years. In an aging population, the challenge remains how to treat very elderly patients ≥75 years.

Methods: Between 2010 and 2018, a total of 977 glioblastoma patients were treated at our institution. Of these, 144 patients were ≥75 years at diagnosis. Primary procedure was surgery or biopsy followed by adjuvant treatment, if possible. We retrospectively investigated progression free- (PFS) and overall survival (OS) and looked at potential prognostic factors influencing survival, including Karnofsky performance score (KPS), surgical therapy, adjuvant therapy as well as MGMT promotor methylation status.

Results: In very elderly patients, median age was 79 years (range: 75-110). Biopsy only was performed in 108 patients, resection was performed in 36 patients. Median OS for the entire cohort was 5.9 months. Survival of patients without adjuvant treatment was worse than for those receiving either radiotherapy and/or chemotherapy (1.2 vs. 8.4 months, p<0.001)). Multivariate analysis showed that KPS at presentation (≥70 vs. ≤60), surgery vs. biopsy, and MGMT status (methylated vs. non-methylated) were significantly associated with OS (6.3 vs. 3.9, p=0.002; 12.6 vs. 4.9, p=0.003; and 10.5 vs. 5.0 months, p=0.009, respectively).

Conclusion: For glioblastoma patients ≥75 years of age, the natural course of the disease without treatment devastating. Very elderly patients benefit from multimodal treatment including microsurgical tumor removal. Treatment options and outcomes should be thoughtfully discussed with patients before treatment decisions are made.