title: Combined-Modality Therapy With Radiation and Chemotherapy for Elderly Patients With Glioblastoma in the Temozolomide Era: A National Cancer Database Analysis.
abstract: The optimal management for elderly patients with glioblastoma (GBM) is controversial. Following maximal safe resection or biopsy, accepted treatment paradigms for elderly patients with GBM include combined-modality therapy (CMT) with both radiotherapy (RT) and chemotherapy (CT), RT alone, and CT alone.
  
  
  
  To evaluate the overall survival (OS) outcomes associated with RT, CT, and CMT for elderly patients with GBM in the modern temozolomide era.
  
  
  
  In this retrospective cohort study of a prospectively maintained, multi-institutional national cancer registry, the National Cancer Database was queried for elderly patients (≥65 years) with newly diagnosed GBM from January 1, 2005, through December 31, 2011, with complete data sets for RT, CT, tumor resection, Charlson-Deyo comorbidity scores, age, sex, and year of diagnosis. Data analysis was performed from October 2015 through December 2015.
  
  
  
  Combined-modality therapy, RT, CT.
  
  
  
  Survival by treatment cohort was estimated using the Kaplan-Meier method and analyzed using the log rank test, univariate and multivariate Cox models, and propensity score-matched analyses.
  
  
  
  A total of 16 717 patients (median [range] age, 73 [65-≥90 y]; 8870 [53%] male) were identified. The median OS by treatment was 9.0 (95% CI, 8.8-9.3) months with CMT (8435 patients), 4.7 (95% CI, 4.5-5.0) months with RT alone (1693 patients), 4.3 (95% CI, 4.0-4.7) months with CT alone (1018 patients), and 2.8 (95% CI, 2.8-2.9) months with no therapy (5571 patients) (P < .001). On multivariate analysis, CMT was superior to both CT alone (hazard ratio, 1.50 [95% CI, 1.40-1.60]; P < .001) and RT alone (hazard ratio, 1.47 [95% CI, 1.39-1.55]; P < .001), whereas no differences were observed between CT alone vs RT alone (P = .60). Propensity score-matched analyses redemonstrated improved OS with CMT over CT alone (P = .002) and RT alone (P < .001); no differences were observed between CT alone vs RT alone (P = .44). On subgroup analyses, a consistent OS advantage was observed with CMT over both CT alone and RT alone across each age stratification (65-69, 70-74, 75-79, and ≥80 years) and among patients treated with or without tumor resection (all P < .001).
  
  
  
  In this analysis of multimodality therapy for elderly patients with GBM, OS was superior with CMT compared with CT alone and RT alone. Survival was similar between CT alone and RT alone, and both CT alone and RT alone were superior to no therapy. This analysis supports the use of CMT for suitable elderly candidates.
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Rusthoven
authors.affiliation: Department of Radiation Oncology, University of Illinois at Chicago School of Medicine, Chicago3Department of Radiation and Cellular Oncology, University of Chicago School of Medicine, Chicago, Illinois.
authors.forename: Matthew
authors.initials: M
authors.lastname: Koshy
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern, Dallas.
authors.forename: David J
authors.initials: DJ
authors.lastname: Sher
authors.affiliation: Division of Neuro-Oncology, Department of Neurology, University of Colorado School of Medicine, Aurora.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Ney
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora.
authors.forename: Laurie E
authors.initials: LE
authors.lastname: Gaspar
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora.
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Jones
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora.
authors.forename: Sana D
authors.initials: SD
authors.lastname: Karam
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora.
authors.forename: Arya
authors.initials: A
authors.lastname: Amini
authors.affiliation: Department of Neurosurgery, University of Colorado School of Medicine, Aurora.
authors.forename: D Ryan
authors.initials: DR
authors.lastname: Ormond
authors.affiliation: Department of Neurosurgery, University of Colorado School of Medicine, Aurora.
authors.forename: A Samy
authors.initials: AS
authors.lastname: Youssef
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kavanagh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D011878:Radiotherapy / Q000379:methods*; D000077204:Temozolomide; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide