Surgical and oncological score to estimate the survival benefit of resection and chemoradiotherapy in elderly (≥70 years) glioblastoma patients: A preliminary analysis

Mark J Zorman; Philip Webb; Mickaela Nixon; Sanskrithi Sravanam; Susan Honeyman; Meera Nandhabalan; Vasileios Apostolopoulos; Richard Stacey; Claire Hobbs; Puneet Plaha

doi:10.1093/noajnl/vdac007

Surgical and oncological score to estimate the survival benefit of resection and chemoradiotherapy in elderly (≥70 years) glioblastoma patients: A preliminary analysis

Neurooncol Adv. 2022 Jan 28;4(1):vdac007. doi: 10.1093/noajnl/vdac007. eCollection 2022 Jan-Dec.

Authors

Affiliations

¹ Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital , Oxford, UK.
² Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK.
³ Medical Sciences Division, University of Oxford, Oxford, UK.
⁴ Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
⁵ Nuffield Department of Surgical Sciences, University of Oxford, UK.

Abstract

Background: Elderly patients with glioblastoma are perceived to face a poor prognosis with perceptions surrounding older age and a relative lack of randomized data contributing. This study evaluated survival prognosticators in elderly glioblastoma patients to more accurately guide their treatment.

Methods: The records of 169 elderly (≥70 years) patients with a new diagnosis of glioblastoma who had undergone neurosurgical intervention were retrospectively examined for patient sex, age, performance status, comorbidities, MGMT promoter methylation, surgical intervention, and chemoradiation regime. The adjusted survival impact of these factors was determined using Cox proportional hazards model and used to devise a two-stage scoring system to estimate patient survival at the stage of surgical (Elderly Glioblastoma Surgical Score, EGSS) and oncological management (Elderly Glioblastoma Oncological Score, EGOS).

Results: The median overall survival (mOS) of the cohort was 28.8 weeks. Gross-total and subtotal resection were associated with improved survival compared to biopsy alone (respective mOS 65.3 and 28.1 vs 15.7 weeks, P < .001). Hypofractionated radiotherapy (40Gy in 15 fractions) with Temozolomide was noninferior to the Stupp protocol, P = .72. Exploratory subgroup analysis revealed a significant benefit of Temozolomide-based approaches in MGMT-methylated patients as well as a trend towards improved survival in MGMT-unmethylated patients. Our EGSS and EGOS scores successfully estimated survival in this retrospective cohort with 65% and 73% accuracy.

Conclusions: Where appropriate and safe, elderly glioblastoma patients may benefit from surgical resection and combined chemoradiotherapy with Temozolomide. The proposed EGSS and EGOS scores take into account important prognostic factors to help guide which patients should receive such treatment.

Keywords: chemotherapy; elderly; glioblastoma; radiotherapy; surgery.