First impressions count: Initial clinical and radiological features independently predict for overall survival in older patients with Glioblastoma


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Cressida Lorimer1,Catherine Hanna2,Anthony Chalmers2,Frank Saran3,Juliet Brock4
1Brighton and Sussex Medical School,2Beatson West of Scotland Cancer Centre,3The Royal Marsden Hospital,4Sussex Cancer Centre

Abstract

Background

Glioblastoma (GBM) is a devastating disease with median life expectancy of 12-15 months, falling to 3-5 months amongst those over 70. Survival rates for older patients are influenced by increased frailty, more aggressive tumour biology and fear of toxicities leading to under treatment. There is an urgent need to improve outcomes whilst maintaining quality of life amongst this vulnerable group.

There is evidence to support giving single agent chemotherapy, radiotherapy or hypofractionated concurrent chemoradiotherapy to older patients with GBM, however the clinical assessments guiding treatment decisions are poorly researched. This retrospective, multicentre study assessed whether pre-morbid characteristics or tumour imaging features could predict for overall survival in a cohort of older patients with GBM.

Method

Patients aged > 70, diagnosed with a GBM at three neuro oncology centres from 2010 to 2015 were retrospectively analysed. Demographic, clinical, radiological and treatment details were included in a multivariate model to examine for predictors of overall survival (OS).

Results

339 patients were included with median OS of 3.8 months. 1 and 2 year OS rates were 13% and 4% respectively. Median age at diagnosis was 75. Pre-treatment characteristics predicting for OS included ECOG performance status over 0 (PS 1 HR 1.66 p=0.042, PS 2 HR 1.78 p=0.031, PS 3 HR 2.20 p=0.008 and PS 4 HR 2.40 p=0.021), radiological evidence of mass effect (HR 1.31 p=0.049), multifocal tumours (HR 3.419, p=0.013), presenting with seizures (HR 0.63, p=0.008) and tumours confined to the cerebral hemisphere (HR 0.59 p=0.048). Subtotal resection decreased risk of death by 37% (p=0.019) and total tumour resection by 44% (p=0.019). Palliative radiotherapy decreased risk of death by 41% (p=0.005), TMZ alone by 60% (p=0.004) and radical chemo-radiotherapy by 81% (p<0.001).

Conclusion

Clinical presentation, PS and imaging characteristics are independent prognostic indicators of OS in older GBM patients, irrespective of age or treatment received.