Elderly Glioblastoma: Long-Course Versus Short-Course Chemoradiotherapy: A Regional New Zealand Retrospective Review

Elderly patients make up a large proportion of those diagnosed with glioblastoma. There are multiple treatment options available for elderly patients including conventional and hypofractionated chemoradiotherapy, chemotherapy monotherapy and best supportive care; therefore, management decision-making can be complex. This retrospective study aims to compare overall survival (OS) and review prognostic factors in patients aged 65 and above who received either long-course or short-course chemoradiotherapy in regional New Zealand.

A regional New Zealand Neurosurgical database identified patients aged ≥ 65 who received the EORTC-NCIC long-course radiotherapy (60Gy in 30 fractions) or the NCIC-CTG short-course radiotherapy (40Gy in 15 fractions), both with concomitant and adjuvant temozolomide.

76 patients diagnosed between 2006 and 2018 were included for analysis. Median OS for those receiving long-course (n = 59) was 15.4 months and for those receiving short-course (n = 17) was 16.9 months. 12-month estimated OS probability was 73% for long-course and 65% for short-course. 24-month estimated OS probability was 22% for long-course and 18% for short-course. There was no statistically significant difference in OS between the two treatment regimes. In a median-regression testing analysis there was insufficient evidence to show that extent of surgical resection, timing of radiotherapy from surgery and use of steroids during radiotherapy were prognostic factors. MGMT methylation status was seldom available for patients during this time.

In this study, median OS of elderly patients receiving long-course or short-course chemoradiotherapy was similar. Short-course chemoradiotherapy should routinely be considered in all elderly patients.