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Journal of Cancer Research and Clinical Oncology

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Open Access 01-01-2021 | Glioblastoma | Original Article – Clinical Oncology

Age-stratified clinical performance and survival of patients with IDH-wildtype glioblastoma homogeneously treated by radiotherapy with concomitant and maintenance temozolomide

Authors: Kerstin Berger, Bernd Turowski, Jörg Felsberg, Bastian Malzkorn, Guido Reifenberger, Hans-Jakob Steiger, Wilfried Budach, Jan Haussmann, Johannes Knipps, Marion Rapp, Daniel Hänggi, Michael Sabel, Hendrik-Jan Mijderwijk, Marcel A. Kamp

Published in: Journal of Cancer Research and Clinical Oncology | Issue 1/2021

Abstract

Objective

Isocitrate dehydrogenase (IDH)-wildtype glioblastomas are the most malignant glial tumours. Median survival is only 14–16 months after diagnosis, with patients aged ≥ 65 years reportedly showing worse outcome. This study aimed to further evaluate the prognostic role of age in a homogenously treated patient cohort.

Methods

The study includes 132 IDH-wildtype glioblastoma patients treated between 2013 and 2017 with open resection followed by radiotherapy with concomitant and maintenance temozolomide. Patients were dichotomized into a non-elderly (< 65 years) and an elderly (≥ 65 years) group. Extent of resection and the O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status were determined for each tumour. Clinical and radiological follow-up data were obtained at 6 weeks after the end of radiation therapy and thereafter in 3-month intervals. Progression-free survival (PFS) and overall survival (OS) were evaluated in univariate and multivariate cox regression analyses.

Results

The elderly group consisted of 58 patients (median age: 70.5 years) and the non-elderly group of 74 patients (median age: 55 years). Median pre- and postoperative operative Karnofsky Performance Scale (KPS), Eastern Cooperative Oncology Group (ECOG) score and National Institutes of Stroke Scale (NIHSS) were not significantly different between the groups, but KPS and ECOG scores became significantly worse in the elderly group at 6 weeks after termination of radiation therapy. Neither PFS nor OS differed significantly between the age groups. Patients with MGMT promoter-methylated tumours survived longer.

Conclusion

Elderly patients in good pre- and postoperative clinical conditions may show similar outcome as younger patients when treated according to standard of care. However, elderly patients may suffer more frequently from clinical deterioration following chemoradiotherapy. In both age groups, MGMT promoter methylation was linked to longer PFS and OS.

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Title: Age-stratified clinical performance and survival of patients with IDH-wildtype glioblastoma homogeneously treated by radiotherapy with concomitant and maintenance temozolomide
Authors: Kerstin Berger
Bernd Turowski
Jörg Felsberg
Bastian Malzkorn
Guido Reifenberger
Hans-Jakob Steiger
Wilfried Budach
Jan Haussmann
Johannes Knipps
Marion Rapp
Daniel Hänggi
Michael Sabel
Hendrik-Jan Mijderwijk
Marcel A. Kamp
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keywords: Glioblastoma
Glioblastoma
Radiotherapy
Glioblastoma
Published in: Journal of Cancer Research and Clinical Oncology / Issue 1/2021
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-020-03334-3

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