Elderly Patients With Glioblastoma and Good Prognostic Factors May Achieve Equivalent Median Survival to Younger Patients When Managed With Standard Long-Course Rather Than Elderly Protocols.

Introduction: Decision-making for adjuvant therapy regimen of elderly patients with glioblastoma may be based on age alone rather than prognostic factors. This study assesses treatment outcomes for elderly patients with good prognostic factors managed with the EORTC-NCIC Protocol.

Methods: Patients treated for glioblastoma with adjuvant chemoradiotherapy in accordance with the EORTC-NCIC (Stupp) Protocol between 2008 and 2021 were entered into a prospective database. Outcomes for patients aged < 65 were compared to those ≥ 65 years, divided into subgroups 65-70, 70-74 and > 75 years. Overall survival (OS) and progression-free survival (PFS) were the primary and secondary endpoints, respectively.

Results: The study included 437 patients, of whom 319 were aged < 65 and 118 were aged ≥ 65 years. Median OS was 19.2 months for patients aged < 65 years and 15.0 months for those aged ≥ 65 years (p = 0.006). Median PFS were 12.0 and 11.3 months, respectively (p = 0.119). For both age groups, performance status, extent of resection and MGMT methylation were significant predictors of overall survival. Age group was not a significant predictor of OS when these factors were accounted for (p = 0.237).

Conclusion: When stratified for performance status and MGMT methylation, elderly patients had similar outcomes compared with the younger cohort. This suggests that elderly patients who managed well following diagnosis and subsequent surgical procedure may be optimally treated with long-course standard rather than elderly protocols.