title: Improved survival for elderly married glioblastoma patients : Better treatment delivery, less toxicity, and fewer disease complications.
abstract: OBJECTIVE
  Marital status is a well-described prognostic factor in patients with gliomas but the observed survival difference is unexplained in the available population-based studies.
  
  
  METHODS
  A series of 57 elderly glioblastoma patients (≥70 years) were analyzed retrospectively. Patients received radiotherapy or chemoradiation with temozolomide. The prognostic significance of marital status was assessed. Disease complications, toxicity, and treatment delivery were evaluated in detail.
  
  
  RESULTS
  Overall survival was significantly higher in married than in unmarried patients (median, 7.9 vs. 4.0 months; p = 0.006). The prognostic significance of marital status was preserved in the multivariate analysis (HR, 0.41; p = 0.011). Married patients could receive significantly higher daily temozolomide doses (mean, 53.7 mg/m² vs. 33.1 mg/m²; p = 0.020), were more likely to receive maintenance temozolomide (45.7 % vs. 11.8 %; p = 0.016), and had to be hospitalized less frequently during radiotherapy (55.0 % vs. 88.2 %; p = 0.016). Of the patients receiving temozolomide, married patients showed significantly lower rates of hematologic and liver toxicity. Most complications were infectious or neurologic in nature. Complications of any grade were more frequent in unmarried patients (58.8 % vs. 30.0 %; p = 0.041) with the incidence of grade 3-5 complications being particularly elevated (47.1 % vs. 15.0 %; p = 0.004).
  
  
  CONCLUSIONS
  We found poorer treatment delivery as well as an unexpected severe increase in toxicity and disease complications in elderly unmarried glioblastoma patients. Marital status may be an important predictive factor for clinical decision-making and should be addressed in further studies.
authors.affiliation: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitätsstraße 27, 91054, Erlangen, Germany. florian.putz@uk-erlangen.de.
authors.forename: Florian
authors.identifier: http://orcid.org/0000-0003-3966-2872
authors.initials: F
authors.lastname: Putz
authors.affiliation: Professorship of Demography, University of Bamberg, Feldkirchenstraße 21, 96052, Bamberg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Putz
authors.affiliation: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitätsstraße 27, 91054, Erlangen, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Goerig
authors.affiliation: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitätsstraße 27, 91054, Erlangen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Knippen
authors.affiliation: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitätsstraße 27, 91054, Erlangen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gryc
authors.affiliation: Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Ilker
authors.initials: I
authors.lastname: Eyüpoglu
authors.affiliation: Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Rössler
authors.affiliation: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitätsstraße 27, 91054, Erlangen, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Semrau
authors.affiliation: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitätsstraße 27, 91054, Erlangen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Lettmaier
authors.affiliation: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitätsstraße 27, 91054, Erlangen, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Fietkau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000401:mortality* / Q000523:psychology; D001932:Brain Neoplasms / Q000401:mortality* / Q000523:psychology / Q000532:radiotherapy*; D015984:Causality; D005260:Female; D005858:Germany / Q000453:epidemiology; D005909:Glioblastoma / Q000401:mortality* / Q000523:psychology / Q000532:radiotherapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D011832:Radiation Injuries / Q000401:mortality* / Q000523:psychology; D012189:Retrospective Studies; D012307:Risk Factors; D018454:Spouses / Q000523:psychology / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Elderly; Glioblastoma; Marital status; Radiotherapy; Temozolomide