Management of Glioblastoma in Elderly Patients in a Single Australian Centre

Glioblastoma management in elderly patients is challenging. The aim of this study was to review oncological treatment strategies at a single institution from 2011 to 2020.

Patients aged ≥ 70 years who received radiotherapy and/or chemotherapy for radiological or histological glioblastoma were identified from a centralised database. Patients receiving supportive care only were excluded, whether or not they had surgery at diagnosis. Clinicopathologic data and treatment modalities were collected. Median survival from diagnosis was calculated by the Kaplan-Meier method.

Seventy-eight people were identified during the study period, median age 74.5 years (range 70-88). Seventy-five people had surgery (24 biopsy only, and 51 resection) and three people had radiological diagnosis only. The most common first-line treatment was concurrent chemoradiation (33/78, 42%). Only 18/33 (55%) went on to receive adjuvant temozolomide, median of five cycles (interquartile range [IQR] 2-6). The most common radiotherapy dose was 40 Gy in 15 fractions (52/73, 71%) and 60 Gy in 30 fractions was less frequently prescribed over time. Second-line therapy for recurrent or progressive disease was received in 23% overall, and varied in modality. Median survival was 7.0 months (IQR 4.4-12.5), and 6.4% (CI 4.3%-9.1%) at 2 years.

Survival is poor for elderly patients with glioblastoma despite treatment. Concurrent chemoradiation was the most common treatment strategy, and 40 Gy in 15 fractions was the most common radiotherapy schedule. A small proportion of people received treatment for recurrent disease, and modality varied greatly.