Top

Published in:

01-11-2018 | Clinical Study

Treatment recommendations for elderly patients with newly diagnosed glioblastoma lack worldwide consensus

Authors: Joshua D. Palmer, Deepak Bhamidipati, Minesh Mehta, Noelle L. Williams, Adam P. Dicker, Maria Werner-Wasik, Wenyin Shi

Published in: Journal of Neuro-Oncology | Issue 2/2018

Abstract

Background

Glioblastoma predominantly occurs in the 6th and 7th decades of life. The optimal treatment paradigm for elderly patients is not well established. We sampled current worldwide management strategies for elderly patients with newly diagnosed glioblastoma.

Methods

A web-based survey was developed and distributed to 168 radiation oncologists, neuro-oncologists and neurosurgeons identified through the United Council for Neurologic Subspecialties and the CNS committees for North American, European and Asian Organizations. Questions addressed treatment recommendations in order to determine whether management consensus exists in this patient subset.

Results

There were 68 (40%) respondents. Across respondents, the most important factors directing treatment were KPS (94%) and MGMT methylation status (71%). Only 37% of respondents strictly factor in age when making treatment recommendations with 59% defining elderly as greater than 70 years-old. The most common treatment recommendations for MGMT-methylated elderly patients with KPS > 70 were as follows: standard chemoRT (49%), short course chemoRT (39%), and temozolomide alone (30%). The most common treatment recommendations for MGMT-unmethylated patients with KPS > 70 were as follows: short course RT alone (51%), standard chemoRT (38%), and short course chemoRT (28%). Treatment recommendations for patients with KPS < 50 were short course RT alone (40%), best supportive care (57%), or TMZ alone (17%). Individuals practicing in North America were significantly more likely to recommend standard chemoradiation for patients compared to their European counterparts.

Conclusion

Worldwide treatment recommendations for elderly patients with newly diagnosed GBM vary widely. Further randomized studies are needed to elucidate the optimal treatment strategy for this subset of patients.

Available only for authorised users

Ostrom QT, Gittleman H, Xu J et al (2016) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2009–2013. Neuro Oncol 18(suppl_5):v1–v75. https://doi.org/10.1093/neuonc/now207 CrossRefPubMedPubMedCentral

Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996. https://doi.org/10.1056/NEJMoa043330 CrossRefPubMed

Stupp R, Hegi ME, Mason WP et al (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10(5):459–466. https://doi.org/10.1016/S1470-2045(09)70025-7 CrossRefPubMed

Iwamoto FM, Reiner AS, Panageas KS, Elkin EB, Abrey LE (2008) Patterns of care in elderly glioblastoma patients. Ann Neurol 64(6):628–634. https://doi.org/10.1002/ana.21521 CrossRefPubMed

Wick W, Platten M, Meisner C et al (2012) Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Oncol 13(7):707–715CrossRefPubMed

Malmström A, Grønberg BH, Marosi C et al (2012) Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol 13(9):916–926. https://doi.org/10.1016/S1470-2045(12)70265-6 CrossRefPubMed

Perry JR, Laperriere N, O’Callaghan CJ et al (2017) Short-course radiation plus temozolomide in elderly patients with glioblastoma. N Engl J Med 376(11):1027–1037. https://doi.org/10.1056/NEJMoa1611977 CrossRefPubMed

Guedes de Castro D, Matiello J, Roa W et al (2017) Survival outcomes with short-course radiation therapy in elderly patients with glioblastoma: data from a randomized phase 3 trial. Int J Radiat Oncol Biol Phys 98(4):931–938. https://doi.org/10.1016/j.ijrobp.2017.03.037 CrossRefPubMed

Sulman EP, Ismaila N, Armstrong TS et al (2016) Radiation therapy for glioblastoma: American society of clinical oncology clinical practice guideline endorsement of the American society for radiation oncology guideline. J Clin Oncol 35(3):361–369. https://doi.org/10.1200/JCO.2016.70.7562 CrossRefPubMed

10.

Lorimer CF, Saran F, Chalmers AJ, Brock J (2016) Glioblastoma in the elderly—how do we choose who to treat? J Geriatr Oncol 7(6):453–456. https://doi.org/10.1016/j.jgo.2016.07.005 CrossRefPubMed

11.

Sijben AE, McIntyre JB, Roldán GB et al (2008) Toxicity from chemoradiotherapy in older patients with glioblastoma multiforme. J Neurooncol 89(1):97–103. https://doi.org/10.1007/s11060-008-9593-6 CrossRefPubMed

12.

Wilke C, Grosshans D, Duman J, Brown P, Li J (2017) Radiation-induced cognitive toxicity: pathophysiology and interventions to reduce toxicity in adults. Neuro Oncol. https://doi.org/10.1093/neuonc/nox195 CrossRefPubMedCentral

13.

Martinez-Tapia C, Paillaud E, Liuu E et al (2017) Prognostic value of the G8 and modified-G8 screening tools for multidimensional health problems in older patients with cancer. Eur J Cancer 83:211–219. https://doi.org/10.1016/j.ejca.2017.06.027 CrossRefPubMed

14.

Franceschi E, Depenni R, Paccapelo A et al (2016) Which elderly newly diagnosed glioblastoma patients can benefit from radiotherapy and temozolomide? A PERNO prospective study. J Neurooncol 128(1):157–162. https://doi.org/10.1007/s11060-016-2093-1 CrossRefPubMed

15.

Central Nervous System Cancers (Version I. 2017). August 2017. https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf

Title: Treatment recommendations for elderly patients with newly diagnosed glioblastoma lack worldwide consensus
Authors: Joshua D. Palmer
Deepak Bhamidipati
Minesh Mehta
Noelle L. Williams
Adam P. Dicker
Maria Werner-Wasik
Wenyin Shi
Publication date: 01-11-2018
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 2/2018
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-018-2969-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Treatment recommendations for elderly patients with newly diagnosed glioblastoma lack worldwide consensus

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2018

Pediatric intracranial ependymoma: correlating signs and symptoms at recurrence with outcome in the second prospective AIEOP protocol follow-up

Postoperative stereotactic radiosurgery for patients with resected brain metastases: a volumetric analysis

Prediction value of unmeasurable MR enhancement at early stage after gross-total resection on the survival state of patients with high-grade glioma

Impact of adjuvant treatments on survival in Korean patients with WHO grade II gliomas: KNOG 15-02 and KROG 16-04 intergroup study

Pretreatment dynamic contrast-enhanced MRI biomarkers correlate with progression-free survival in primary central nervous system lymphoma

Non-invasive genotype prediction of chromosome 1p/19q co-deletion by development and validation of an MRI-based radiomics signature in lower-grade gliomas