TITLE:
Treatment in Elderly Glioblastoma Patients: General Reduction of Standard Therapy Should Be Avoided. Prognostic Value of MGMT Is Questionable
AUTHORS:
Josef Pichler, Isolde Hoellmüller, Bahil Ghanim, Sabine Spiegl-Kreinecker
KEYWORDS:
Glioblastoma; Elderly Patients; MGMT; Standard Therapy
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.4 No.7,
August
26,
2013
ABSTRACT:
Purpose: Aim of this single
center study was to determine whether elderly patients benefit from
individualized treatment not excluding full standard therapy. Additionally
predictive and prognostic factors influencing outcome in this patient’s population were evaluated. Material and Methods: Between 1997 and 2010, 119 patients equal or
older than 60 years were enrolled in this retrospective review. All patients
had neuropathology confirmed diagnosis of glioblastoma. Treatment outcome
concerning progression free survival was measured by MRI. For evaluation of O6-Methylguanin-DNA-methyltransferase (MGMT)
Methylation-specific PCR was used. The log rank test and the Cox proportional
hazards model were used to analyze the data. Factors considered in univariate and
multivariate analyses included age, gender, Karnofsky performance scale (KPS),
extent of resection, treatment with radioand chemotherapy and MGMT status.
Survival probabilities were estimated by means of the Kaplan Meier method. Results: Multivariate analysis
demonstrated age, KPS and treatment more than surgery as prognostic factors for
survival and sex, KPS, type of surgery and standard treatment as independent
factors for PFS. MGMT status revealed no difference in survival between the
methylated and unmethylated tumours in the whole study population (12.7 and
12.0, respectively). Surgery had an impact on survival with a significant
advantage for complete resection. Conclusion: Extent of resection is essential even in elderly patients. Full standard treatment
should be offered to elderly GBM patients with good clinical performance, there
is no reason to withhold radioor chemotherapy from these patients. MGMT
promotor methylation of the tumour is not relevant for treatment decision.