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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Elderly patients with glioblastoma multiforme – when is best supportive care the best option?

Patienten im fortgeschrittenen Alter mit Glioblastoma multiforme – wann ist best supportive care die beste Therapiemöglichkeit?

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  • presenting/speaker Pawel Jarski - Georg-August University Göttingen, Neurosurgery, Göttingen, Deutschland
  • Christian von der Brelie - Georg-August University Göttingen, Neurosurgery, Göttingen, Deutschland
  • Veit Rohde - Georg-August University Göttingen, Neurosurgery, Göttingen, Deutschland
  • Silvia Hernández-Durán - Georg-August University Göttingen, Neurosurgery, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP073

doi: 10.3205/21dgnc361, urn:nbn:de:0183-21dgnc3613

Published: June 4, 2021

© 2021 Jarski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Frailty is an emerging concept often used in geriatric medicine to denote a syndrome of physiological decline, characterized by marked vulnerability to adverse health outcomes. Studies have shown that frailty can predict outcome in elderly patients undergoing craniotomies for primary central nervous system tumors. In this study, we aim to determine whether frailty can identify elderly patients suffering from glioblastoma multiforme (GBM) at increased risk for adverse outcomes.

Methods: We conducted a retrospective study of elderly patients, aged 65 years or older, diagnosed with GBM at our institution from January 2010 to September 2020. We evaluated patient’s frailty with the clinical frailty scale (CFS), and dichotomized them in “frail” for CFS ≥5, and “not frail” for CFS <5. Extent of resection (EoR), molecular markers (MGMT methylation status, IDH-1 mutation status, and ATRX status), and adjuvant therapies were recorded. These established predictive variables were compared among both groups by means of Chi Square test. Primary endpoint was overall survival (OS), assessed with a log-rank test.

Results: A total of 82 patients were included in the study, of which 19 were lost to follow-up. Of the remaining 63 patients, 13 (22%) were categorized as “frail”. No statistically significant difference was observed among both groups regarding EoR or molecular pathological profile. However, frail patients were not considered suitable candidates for adjuvant concomitant radiochemotherapy in 9/13 cases, a statistically significant difference to non-frail patients, who underwent Stupp protocol in 42/50 cases (p<.001). Frail individuals had a statistically significant lower mean OS of 3.3 months, when compared to “non-frail” patients, whose mean OS was 9.8 months (p=.002).

Conclusion: Frailty screening in neuro-oncologic patients could aid in risk stratification and clinical decision-making, identifying individuals who might be better suited for best supportive care instead of maximal neuro-oncologic therapy.