Comprehensive geriatric assessment (CGA) can categorize elderly glioblastoma (GBM) patients into three groups predicting survival: A monoinstitutional study

Abstract

Background: Treatment for GBM elderly patients (pts) is a challenge in neuro-oncology. The CGA is currently used for assessing elderly pts and its score correlates with outcome in many types of tumors. We have reported some general outcomes of CGA in GBM pts. Here we performed a large retrospective analysis for identifying specific CGA category correlations with PFS and OS Methods: Pts aged >=65 years, with histological diagnosis of GBM and availability of CGA result were enrolled. The CGA was administered before starting radio/chemotherapy (RT/CH) or palliative care Results: we enrolled 113 pts; median age was 71.7 years. Radical surgery was performed in 33% of cases; 80% of pts were treated with RT/CH combination; median number of maintenance temozolomide (TMZ) cycles was 3.9. Most pts had a high Karnofsky Perfrmance Score (80%). According to CGA score, 35% of pts were categorized as "fit", 30% as "vulnerable" and 35% were "frail", and median overall survival was 16.5 vs 12.1 vs 10.3 months (p=0.1). On multivariate analysis, CGA score proved an independent predictor of survival: vulnerable and frail pts reported an HR of 1.5 and 2.2, respectively, compared to fit pts (p=0.04). Moreover, we demonstrated a statistical association between CGA and type of treatment, fit pts being more frequently treated with RT/ CT (98% vs 90% and 52% of vulnerable and frail pts, respectively, p<0.001); yet, frail pts received fewer cycles of maintenance TMZ than vulnerable and fit (2.8 vs 5 and 5.2, respectively; p<0.001). No association between CGA and PFS was demonstrated. Conclusion(s): CGA score was shown to be a significant predictor of mortality in elderly GBM pts. The score can classify pts into three categories statistically correlating with survival. It could be a useful treatment decision tool suggesting the more appropriate treatment. However, a prospective study is warranted.