title: Outcome of treatment of recurrent glioblastoma multiforme in elderly and/or frail patients.
abstract: Optimal treatment of recurrent glioblastoma multiforme (rGBM) in elderly and/or frail patients remains virtually unexplored, the best supportive care (BSC) only is routinely administered due to the fatal prognosis. We evaluated the impact of different treatment methods on post-progression survival (PPS) and overall survival (OS) of such patients. Data from 98 elderly and/or frail rGBM patients, treated initially with 1-week or 3-week radiotherapy (RT) within the phase III IAEA study (2010-2013), were analyzed. KPS at relapse and salvage treatment methods were recorded. Kaplan-Meier method was used to estimate PPS and OS for different treatment modalities. Eighty-four patients experienced recurrence: 47 (56%) received BSC, 21 (25%)-chemotherapy (CHT), 8 (9.5%)-surgery, 3 (3.5%)-RT, for 5 (6%) the data was unavailable. Median OS from randomization for all 84 patients was 35 weeks: 55 versus 30 weeks for any treatment versus BSC, p < 0.0001. Median PPS was 15 weeks: 23 weeks with any treatment versus 9 weeks with BSC, p < 0.0001. For local treatment (surgery and/or RT) median PPS was 51 versus 21 weeks for CHT, p = 0.36. In patients with poor KPS (≤60) at relapse median PPS was 9 weeks with BSC versus 21 weeks with any treatment, p = 0.014. In poor KPS patients median PPS for local treatment was 14 weeks versus 21 weeks with CHT, p = 0.88. An active therapeutic approach may be beneficial for selected elderly and/or frail rGBM patients. Poor KPS patients may also benefit from active treatment, but there is no benefit of local treatment over CHT.
authors.affiliation: Department of Radiotherapy, Regional Oncology Center, ul. Bialska 104/118, 42-200, Czestochowa, Poland. sochajoanna@wp.pl.
authors.forename: Joanna
authors.initials: J
authors.lastname: Socha
authors.affiliation: Independent Public Care Facility of the Ministry of the Interior and Warmian & Mazurian Oncology Center, Olsztyn, Poland.
authors.forename: Lucyna
authors.initials: L
authors.lastname: Kepka
authors.affiliation: Department of Radiotherapy, Alberta Health Services-Cancer/University of Alberta, Edmonton, Canada.
authors.forename: Sunita
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Department of Radiotherapy, Alberta Health Services-Cancer/University of Alberta, Edmonton, Canada.
authors.forename: Wilson
authors.initials: W
authors.lastname: Roa
authors.affiliation: Department of Radiotherapy & Oncology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
authors.forename: Narendra
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Radiotherapy, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus.
authors.forename: Valery
authors.initials: V
authors.lastname: Sinaika
authors.affiliation: Department of Radiotherapy, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Juliana
authors.initials: J
authors.lastname: Matiello
authors.affiliation: Department of Radiotherapy, High Technology Medical Center University Clinic, Tbilisi, Georgia.
authors.forename: Darejan
authors.initials: D
authors.lastname: Lomidze
authors.affiliation: Department of Radiotherapy, A C Camargo Hospital, São Paolo, Brazil.
authors.forename: Douglas Guedes
authors.initials: DG
authors.lastname: de Castro
authors.affiliation: Department of Radiotherapy, Institut National de Cancer Salah Azaiz, Tunis, Tunisia.
authors.forename: Dalenda
authors.initials: D
authors.lastname: Hentati
authors.affiliation: Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency, Vienna, Austria.
authors.forename: Elena
authors.initials: E
authors.lastname: Fidarova
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult
keywords: Elderly patients; Frail patients; Recurrent glioblastoma multiforme; Salvage therapy