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A Clinical Review and Treatment Outcome in Glioblastoma: Is Age Only a Number?
Authors: Koul R
Number of views: 659
Introduction: Overall incidence rate of all brain tumors to be 10.82 (95% CI: 8.63–13.56) per 100,000 person-years. Glioblastoma accounts
for up to 60% of all malignant primary brain tumors in adults, occurring in 2-3 cases per 100,000 in Europe and North America. In 2005 maximum
safe surgical resection, followed by radiotherapy with concomitant temozolomide (TMZ), followed by adjuvant TMZ became the standard of care
for glioblastoma. We adopted this as the standard of care in 2009 in the province of Saskatchewan, Canada.
Material and methods: A cohort of 393 consecutive patients with pathologically proven glioblastoma, who had been registered in the Province
of Saskatchewan from 2000 to 2010, was examined. Survival analysis was performed using Kaplan-Meier curves and log-rank test for comparing
subgroups. The independent effect of factors that predicted survival at the bivariate level was determined using a Cox proportional hazard model.
Results: Median age at diagnosis was 67 years in females and 63 years in males. The median overall survival was 13.8 months (95% CI:
12.6, 15.1 months). Based on a literature review and after the univariate analysis, the following variables were included in the Cox’s multivariable
model: age at diagnosis, ECOG status (dichotomous variable created), type of surgery (complete vs. sub-total), and whether chemotherapy and
radiotherapy were given after surgery. Patients who treated with chemotherapy and chemotherapy had a better median survival of 18.1 months
vs. 11.3 months without chemotherapy. Patients younger than 50 years did better as compared to elderly population. For fit elderly patients >70
years, 11.0 months median survival was achieved. Contrary to common belief in literature, patients with headache do not have a worse survival
and patients who presented with seizure survived better.
Conclusion: Our series demonstrates improved survival outcomes for patients <50 years old quite consistent with literature. However for
elderly patients with excellent performance status in the western Canadian province, a median survival of <70 years 16.1 months (95% CI 13.6-
18.1 months) ≥ 70 years 11.7 months (95% CI: 10.4-13.0 months) was achieved which is better than other series in the current literature. The
landscape of treatment options for GBM patients has changed substantially over the past decade and with further information still amassing
in ongoing clinical trials in GBM population the suggestion is to base treatment options based on patient age and KPS. Until further treatment
advances are made for GBM in general, utilizing the current therapeutic options of surgery, RT, and TMZ appropriately according to patient age,
performance status, and patient preferences represents optimal management.
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