Recurrent glioblastomas in the elderly after maximal first-line treatment: does preserved overall condition warrant a maximal second-line treatment?

• DOI: 10.1007/s11060-017-2573-y
• Publication Date: 2017-07-19T11:40:59Z
• Authors: Marc Zanello; Alexandre Roux; Renata Ursu; Sophie Peeters; Luc Bauchet; Georges Noel; Jacques Guyotat; Pierre-Jean Le Reste; Thierry Faillot; Fabien Litre; Nicolas Desse; Evelyne Emery; Antoine Petit; Johann Peltier; Jimmy Voirin; François Caire; Jean-Luc Barat; Jean-Rodolphe Vignes; Philippe Menei; Olivier Langlois; Edouard Dezamis; Antoine Carpentier; Phong Dam Hieu; Philippe Metellus; Johan Pallud
• Keywords: Aged, 80 and over; Male; Brain Neoplasms; Age Factors; 610; Middle Aged; Prognosis; Combined Modality Therapy; Survival Analysis; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; [INFO.INFO-TI]Computer Science [cs]/Image Processing [eess.IV]; 616; Multivariate Analysis; Humans; Female; Karnofsky Performance Status; Neoplasm Recurrence, Local; Glioblastoma; Aged; Follow-Up Studies; Retrospective Studies

A growing literature supports maximal safe resection followed by standard combined chemoradiotherapy (i.e. maximal first-line therapy) for selected elderly glioblastoma patients. To assess the prognostic factors from recurrence in elderly glioblastoma patients treated by maximal safe resection followed by standard combined chemoradiotherapy as first-line therapy. Multicentric retrospective analysis comparing the prognosis and optimal oncological management of recurrent glioblastomas between 660 adult patients aged of < 70 years (standard group) and 117 patients aged of ≥70 years (elderly group) harboring a supratentorial glioblastoma treated by maximal first-line therapy. From recurrence, both groups did not significantly differ regarding Karnofsky performance status (KPS) (p = 0.482). Oncological treatments from recurrence significantly differed: patients of the elderly group received less frequently oncological treatment from recurrence (p < 0.001), including surgical resection (p < 0.001), Bevacizumab therapy (p < 0.001), and second line chemotherapy other than Temozolomide (p < 0.001). In multivariate analysis, Age ≥70 years was not an independent predictor of overall survival from recurrence (p = 0.602), RTOG-RPA classes 5-6 (p = 0.050) and KPS at recurrence <70 (p < 0.001), available in all cases, were independent significant predictors of shorter overall survival from recurrence. Initial removal of ≥ 90% of enhancing tumor (p = 0.004), initial completion of the standard combined chemoradiotherapy (p = 0.007), oncological treatment from recurrence (p < 0.001), and particularly surgical resection (p < 0.001), Temozolomide (p = 0.046), and Bevacizumab therapy (p = 0.041) were all significant independent predictors of longer overall survival from recurrence. Elderly patients had substandard care from recurrence whereas age did not impact overall survival from recurrence contrary to KPS at recurrence <70. Treatment options from recurrence should include repeat surgery, second line chemotherapy and anti-angiogenic agents.