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Session Item

RTT track: Treatment planning and dose calculation / QC and QA
9345
Poster
RTT
10:54 - 11:02
A score to predict survival of elderly patients newly diagnosed for Glioblastoma
PH-0358

Abstract

A score to predict survival of elderly patients newly diagnosed for Glioblastoma
Authors: Straube|, Christoph(1)*[christoph.straube@mri.tum.de];Kessel|, Kerstin A. (1);Antoni|, Stefanie(1);Gempt|, Jens(2);Meyer|, Bernhard(2);Schlegel|, Juergen(3);Schmidt-Graf|, Friederike(4);Combs|, Stephanie Elisabeth(1);
(1)Klinikum rechts der Isar- TU München, Department of Radiation Oncology, München, Germany;(2)Klinikum rechts der Isar- TU München, Department of Neurosurgery, München, Germany;(3)Klinikum rechts der Isar- TU München, Department of Neuropathology, München, Germany;(4)Klinikum rechts der Isar- TU München, Department of Neurologie, München, Germany;
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Purpose or Objective

Elderly patients with newly diagnosed glioblastoma (GBM) are currently recommended to undergo adjuvant treatment with either normo- or hypofractionated radiotherapy, with or without concomitant and adjuvant chemotherapy. The concrete treatment recommendation is based on the age, the MGMT promotor methylation as well as the performance status. None of these factors is weighted against others. We designed a risk-score to classify elderly GBM patients for their prognosis after histological confirmation.

Material and Methods

181 GBM-patients, 65 years or older were retrospectively analyzed. Clinical characteristics, such as age, KPS, motor function as well as aphasia before and after surgery, the extent of resection as well as the MGMT methylation status were analyzed for their impact on the overall survival (OS). Factors which were significant in univariate analysis (log-rank-test, p<0.05) were included in a multivariate model (multivariate cox-regression analysis, MVA). Significant factors (p<0.05) from this model were included in a prognostic score.

Results

The Age, KPS, MGMT-status, extent of resection, aphasia after surgery and motor-dysfunction after surgery were significantly associated with OS on univariate analysis (p<0.05). On MVA three factors were significant: age (p 0.002), MGMT promotor methylation (p 0.013) and Karnofsky performance status (p 0.005). The resulting score was based on Age (5 points 65 to <70 years, 4 for 70 to <75 years, 3 for 75 to <30 years, 1 for >80 years), KPS (4 points for 100-70%, 2 points for 50-60% and 0 point for <50%) and MGMT-Status (3 for unmethylated or unknown, 5 for methylated). Two groups could be divided, group A (4 to 8) with a median OS of 2.7 months and group B (9 -14) with a median OS of 7.8 months (Figure1, Kaplan Meier curves for the Elderly-Score with a threshold of 8). The score was of prognostic significance, independently from the adjuvant treatment regimen.

Kaplan Meier curves for the Elderly-Score, A) for all Scores and b) with a threshold of 8.


Conclusion

We generated a score, which distinguishes patients with a poor prognosis from patients with a better prognosis. Inclusion of the score in future retro- or prospective trials could help to enhance the comparability of the results. Before its use in daily routine, external validation is recommended.