Treatment of patients with glioma during the COVID-19 pandemic: what we learned and what we take home for the future

OBJECTIVECoronavirus disease 2019 (COVID-19) has changed the way in which cancer is treated. Patients with high-grade glioma (HGG) are believed to be in a vulnerable category. The aim of this study was to describe the experience of a hub cancer center and the measures that were put in place for treatment of patients with newly diagnosed and recurrent glioma.METHODSTo prevent in-hospital contagion and preserve the safety of health professionals and patients, specific protocols and strict regulations were introduced. Physical distancing, use of surgical masks, and diligent hand hygiene were adopted. Each case was discussed in a multidisciplinary board meeting before treatment. All patient candidates for surgical procedures were tested for SARS-CoV-2 with a nasopharyngeal swab and a chest CT scan. Indications for surgery were the radiological suspicion of HGG in patients with a good performance status and/or the rapid and progressive occurrence of neurological deficits. Adjuvant treatments were performed only in cases of HGG. This therapy consisted of conventional fractional radiotherapy (RT; 60 Gy/30 fractions) with concomitant and adjuvant temozolomide chemotherapy (TMZCHT) in younger patients; in elderly patients, a short course of RT was employed (40.5 Gy/15 fractions). For recurrent HGG, treatments were assessed after a careful evaluation of the patient’s general condition, neurological status, and risk of early impairment in neurological status if not treated. During simulation CT for the RT plan, each patient underwent a chest CT study. In cases in which an imaging study was suspicious for COVID-19 pneumonia, the patient was immediately isolated and rapidly underwent nasopharyngeal swab testing.RESULTSBetween March 1 and April 30, 2020, 23 HGGs were treated, and these cases are included in the present evaluation. Fifteen patients harboring newly diagnosed glioblastoma (GBM) underwent resection followed by a regimen of chemotherapy and RT, and 3 patients with newly diagnosed anaplastic oligodendroglioma underwent surgery followed by adjuvant RT. Five patients were treated for recurrent GBM, and they received surgery plus adjuvant RT. One patient in whom the simulation CT study was suspicious for COVID pneumonia was tested with a nasopharyngeal swab, which proved positive for SARS-CoV-2 infection. No patients contracted COVID-19 during hospitalization for surgery or during RT treatment. Corticosteroid therapy was administered to all patients beginning on the 1st day of RT.CONCLUSIONSThe authors’ experience during the COVID-19 pandemic showed that patients with HGG can be treated in the most effective manner without a compromise in safety. Careful selection criteria and a multidisciplinary evaluation are pivotal to assessing the optimal therapeutic strategy.

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Postoperative ischemic changes following brain metastasis resection as measured by diffusion-weighted magnetic resonance imaging

Journal of Neurosurgery ◽

10.3171/2013.9.jns13596 ◽

2013 ◽

Vol 119 (6) ◽

pp. 1395-1400 ◽

Cited By ~ 17

Author(s):

Jens Gempt ◽

Julia Gerhardt ◽

Vivien Toth ◽

Stefanie Hüttinger ◽

Yu-Mi Ryang ◽

...

Keyword(s):

Brain Metastasis ◽

Brain Metastases ◽

Neurological Deficit ◽

Karnofsky Performance Status ◽

Performance Status ◽

Neurological Status ◽

Neurological Deficits ◽

Brain Irradiation ◽

Diffusion Weighted ◽

The Mean

Object Brain metastases occur in 10% to 40% of patients harboring cancer. In cases of neurosurgical metastasis resection, all postoperative neurological deterioration should be avoided. Reasons for postoperative deficits can be direct tissue damage due to resection, hemorrhage, venous congestive infarcts, or arterial ischemic events leading to tissue infarction. The aim of this study was to evaluate whether postoperative ischemic infarctions occur in surgery for brain metastasis and to determine their influence on new postoperative neurological deficits. Methods Patients who underwent resection of brain metastases and had preoperative and early postoperative (within 48 hours) MRI scans, including diffusion-weighted imaging sequences and apparent diffusion coefficient maps, between January 2009 and May 2012 were included in this study. Clinical and histopathological data (histopathological results, pre- and postoperative neurological status, and previous tumor-specific therapy) were recorded. Results One hundred twenty-two patients (56 male, 66 female) who underwent resection of brain metastases were included. The patients' mean age was 60 years (range 21–89 years). The mean time span from initial tumor diagnosis to resection of brain metastasis was 44 months (range 0–338 months). The mean preoperative Karnofsky Performance Status was 80% (exact mean 76% ± 17% [SD]), and the mean postoperative value was 80% (exact mean 78% ± 17%). Twelve (9.8%) of the 122 patients had postoperative permanent worsening of a neurological deficit or a new permanent neurological deficit; 44 (36.1%) of the 122 patients had postoperative ischemic lesions. When comparing patients with and without previous brain irradiation, 53.8% of patients with previous brain irradiation had ischemic lesions on postoperative imaging compared with 31.3% of patients without previous brain irradiation (p = 0.033). There was a significant association between ischemia and postoperative neurological status deterioration (transient or permanent); 13 (29.5%) of 44 patients with ischemic lesions had deterioration of their neurological status compared with 7 (9%) of the 78 patients who did not have ischemic lesions (p = 0.003). Conclusions This study demonstrates a high prevalence of vascular incidents in patients undergoing resection for metastatic brain disease. Patients harboring postoperative ischemic lesions detected by MRI have a higher rate of neurological deficits (transient or permanent). Patients who had previous irradiation therapy are at higher risk of developing postoperative ischemic lesions. A large number of postoperative neurological deficits are caused by ischemic incidents.

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Declining Rates of Treatment-Related Mortality in Patients with Newly Diagnosed Acute Myeloid Leukemia (AML) Given “Intensive” Induction Regimens: A Report From the Southwest Oncology Group (SWOG) and MD Anderson Cancer Center (MDA)

Blood ◽

10.1182/blood.v120.21.129.129 ◽

2012 ◽

Vol 120 (21) ◽

pp. 129-129 ◽

Cited By ~ 3

Author(s):

Megan Othus ◽

Hagop M. Kantarjian ◽

Stephen Petersdorf ◽

Farhad Ravandi ◽

Jorge E. Cortes ◽

...

Keyword(s):

Supportive Care ◽

Conflicts Of Interest ◽

Performance Status ◽

Cancer Center ◽

Cell Transplant ◽

Newly Diagnosed ◽

Secondary Aml ◽

Over Time ◽

Treatment Related Mortality ◽

Related Mortality

Abstract Abstract 129 Background Recent emphasis has been placed on administration of induction regimens less intense than standard 3+7 for patients with newly diagnosed AML. A primary goal is to reduce the presumed average treatment related mortality (TRM) rate of 10% occurring within the first 28 days after start of 3+7 or higher intensity therapies; TRM rates have been > 30% in patients who are older and/or have poor performance status (PS]. (Walter et al. JCO 2012). This practice presupposes that TRM rates with higher intensity induction regimens are static, a notion seemingly difficult to reconcile with advances in supportive care (e.g. newer anti-aspergillosis drugs) that have sharply reduced rates of non-relapse mortality after allogeneic hematopoietic cell transplant (Gooley et al. NEJM 2010). Methods We thus addressed rates of TRM from 1991–2009 in 1,409 patients given 3+7 induction regimens on SWOG protocols (cytarabine dose 100 mg/m2 daily × 7) and 1,933 patients given induction regimens containing higher cytarabine doses (at least 1.0 g/m2 daily × 4–5 days) at MDA, variably combined with idarubicin, fludarabine or other agents. Multivariate analyses were used to account for confounding factors. Results TRM rates declined both in SWOG and at MDA. However this reduction must account for the declining ages of patient given 3+7 or more intense induction (p<0.001 in both SWOG and at MDA) and their improved PS (p<0.001 SWOG and MDA);the considerably younger nature of SWOG patients during 2006–2009 reflects the switch to less intense induction regimens for many older patients; such regimens were not included in this analysis. Additionally other covariates associated with TRM (more blood blasts, lower platelets, secondary AML) by Walter et al. (JCO 2012)were unevenly distributed in the various time periods(for example no secondary AML in SWOG 2006–2009). Multivariate logistic regression was thus performed to account for the effect of age, PS, and these other covariates in the reduction in TRM. After such accounting, odds ratios (ORs) for TRM at MDA were (relative to 1995) 0.89, 0.7, and 0.36 for 1996–2000,2001–2005, and 2006–2009 respectively with the null hypothesis of no change over time rejected at p = 0.006. For SWOG, not including secondary AML as a covariate ORs were (relative to 1991– 1995) 0.75,0.78, and 0.42 for 1996–2000,2001–2005,and 2006–2009 respectively; again the hypothesis of no change with time was rejected (p = 0.037). There were no interactions between reduced TRM and age, WBC or performance status suggesting the reduction in TRM was a general phenomenon. Conclusion There has been a reduction over time in TRM after “intensive” induction possibly due to better supportive care. Although various selection biases cannot be excluded, this decline is not due to younger age or better performance status and needs to be considered when choosing AML induction therapy. Disclosures: No relevant conflicts of interest to declare.

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A Scoring System for Prediction of FLT3-ITD Positivity in Patients with Newly Diagnosed Acute Myeloid Leukemia.

Blood ◽

10.1182/blood.v120.21.2590.2590 ◽

2012 ◽

Vol 120 (21) ◽

pp. 2590-2590

Author(s):

Fabiana Ostronoff ◽

Megan Othus ◽

Hagop M. Kantarjian ◽

Soheil Meshinchi ◽

Farhad Ravandi ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Scoring System ◽

Myeloid Leukemia ◽

Conflicts Of Interest ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Cancer Center ◽

Newly Diagnosed ◽

Wbc Count ◽

Acute Myeloid

Abstract Abstract 2590 Background FLT3-internal tandem duplication (ITD) is found in about 30% of patients with acute myeloid leukemia (AML) at diagnosis and confers a high risk of relapse. Thus allogeneic hematopoietic transplant (HCT) is recommended for these patients in first complete remission (CR) and after HCT they become candidates for trials of FLT3-ITD inhibitors (such as quizartinib) to prevent relapse. However at referral to tertiary centers after reaching CR, FLT3-ITD status at diagnosis is often unknown, complicating decisions about HCT. FLT3-ITDs are known to be associated with a normal karyotype (NK), translocation 6;9 and a high white blood cell (WBC) count, and we hypothesized that assessment of likely FLT3-ITD status at diagnosis in patients presenting in CR not tested at diagnosis would be improved by examining these covariates simultaneously. Methods Our initial analysis included 434 adult patients with newly diagnosed AML (excluding APL) treated on three SWOG trials (S9031, S9333, and S0106) in whom FLT3-ITD status (positive/negative) was established at diagnosis. Univariate and then multivariate analyses were used to identify covariates independently associated with FLT3-ITD positivity. The relative abilities of these to predict FLT3-ITD positivity were quantified using the area under the receiver operator characteristic curve (AUC); an AUC of 1.0 denotes perfect prediction, whereas an AUC of 0.5 is analogous to a coin flip. The log odds ratios (ORs) from the multivariate models were used to assign a score to each covariate and scores were summed; such that the higher the score, the greater is the likelihood of the FLT3-ITD positivity at diagnosis. We tested the performance of the scoring system in 2 newly-diagnosed populations that had not contributed to the system's development and in whom FLT3-ITD status at diagnosis was known: (a) 210 patients treated at FHCRC (Fred Hutchinson Cancer Research Center) and (b) 1,401 patients treated at MDACC (M.D. Anderson Cancer Center). Covariates examined were: age, sex, performance status (PS), WBC count, platelet count, bone marrow blast percentage, secondary AML, and cytogenetic risk (using SWOG/Eastern Cooperative Oncology Group criteria). Results FLT3- ITD was present in 101 of the 434 SWOG patients (23%) in the scoring system development population. The log OR were rounded to the nearest half point to create the scoring system. Only WBC > 20,000 (reference, WBC < 20,000) and cytogenetics (reference, normal) had non-zero scores, which are summarized below: Scores less than −0.5 were called low, ≥−0.5 and <0.5 intermediate, ≥ 0.5 high. The AUC was 0.75 and contrasted with 0.66 and 0.69 when only WBC or cytogenetics were considered. However when this system was tested in the FHCRC population (16% FLT3-ITD positive) its AUC was only 0.58, not better than when each covariate was examined separately (AUC 0.54 and 0.6 for WBC and cytogenetics, respectively). Similarly at MDACC (17% FLT3-ITD positive) the system's AUC was 0.68 vs. 0.59 and 0.68 for WBC and cytogenetics, respectively. Conclusion Although this scoring system seemed useful tool within the population it was developed (SWOG), such was not the case in two independent cohorts of AML patients with known FLT3-ITD status (FHCRC and MDACC). This indicates that there is no obvious substitute for actual data on FLT3-ITD status. Disclosures: No relevant conflicts of interest to declare.

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Factors Associated With Improved Outcomes Following Decompressive Surgery for Prostate Cancer Metastatic to the Spine

Neurosurgery ◽

10.1227/neu.0000000000000070 ◽

2013 ◽

Vol 73 (4) ◽

pp. 657-666 ◽

Cited By ~ 22

Author(s):

Derek G. Ju ◽

Patricia L. Zadnik ◽

Mari L. Groves ◽

Lee Hwang ◽

Paul E. Kaloostian ◽

...

Keyword(s):

Prostate Cancer ◽

Median Survival ◽

Spinal Surgery ◽

Metastatic Cancer ◽

Performance Status ◽

Neurological Status ◽

Neurological Deficits ◽

Intractable Pain ◽

Castration Resistant Prostate Cancer ◽

Mechanical Instability

Abstract BACKGROUND: Metastatic spinal cord compression from prostate cancer is a debilitating disease causing neurological deficits, mechanical instability, and intractable pain. Surgical management may improve quality of life. OBJECTIVE: To define postoperative outcomes and explore associations with prolonged survival for patients with metastatic prostate cancer. METHODS: Retrospective chart reviews were performed of all patients undergoing spinal surgery for metastatic cancer from June 1, 2002 to August 31, 2011. Patient demographics, surgical details, adjuvant therapies, outcomes, complications, and postoperative survival were reviewed. RESULTS: Twenty-seven patients with prostate cancer underwent surgery at a median age of 65 years (range, 46-82 years). After surgery, 93% of patients had preserved or improved neurological status, 56% of nonambulatory patients recovered ambulation, 43% of incontinent patients recovered continence, and 23% experienced complications. Postoperative Frankel grades were significantly improved by at least 1 letter grade at 1 month (P = .03). The median analgesic and steroid usage was significantly lower up to 3 months and 6 months postoperatively, respectively (P = .007, .005). Median survival following surgery was 10.2 months, and patients with castration-resistant prostate cancer had a shorter median survival than those with hormone-naïve disease (9.8 vs 40 months). Better preoperative performance status was an independent predictor of survival (P = .02). Younger age (P = .005) and instrumentation greater than 7 spinal levels (P = .03) were associated with complications. CONCLUSION: Spinal surgery for prostate metastases improves neurological function and decreases analgesic requirements. Our findings support surgical intervention for carefully selected patients, and knowledge of preoperative hormone sensitivity and performance status may help with risk stratification.

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Outcomes of metastatic chromophobe renal cell carcinoma (ChRCC) with sarcomatoid features (SF).

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.678 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 678-678

Author(s):

Yasser Ged ◽

Andrea Knezevic ◽

Yingbei Chen ◽

Almedina Redzematovic ◽

Maria Isabel Carlo ◽

...

Keyword(s):

Clinical Features ◽

Performance Status ◽

Poor Performance ◽

Cancer Center ◽

Poor Performance Status ◽

Newly Diagnosed ◽

First Line ◽

Entire Cohort ◽

First Line Therapy ◽

Line Therapy

678 Background: ChRCC makes up 5-10% of RCC subtypes and is generally thought to confer favorable prognosis. Presence of SF on histologic review can occur in any RCC subtype and is considered a hallmark of aggressive disease. We assessed outcomes in a cohort of patients (pts) with metastatic ChRCC and SF (sChRCC). Methods: Baseline clinical features and details on treatment were collected for pts with newly diagnosed metastatic sChRCC evaluated at Memorial Sloan Kettering Cancer Center (MSKCC) between 2002-17. Overall survival (OS) was calculated for all patients and time to treatment failure (TTF) for those who received first-line therapy at MSKCC. Next generation sequencing (NGS) with MSK-IMPACT was performed in a subset of pts. Results: 27 pts with newly diagnosed metastatic sChRCC were identified; other clinical features are summarized below ( table). 2 pts never received first line therapy based on poor performance status. 16 were treated at MSKCC and received a median of 2 lines of systemic therapy. First line agents included sunitinib (n = 6), pazopanib (n = 2), temsirolimus (n = 2), everolimus + bevacizumab (n = 2), sunitinib + gemcitabine (n = 2) and interferon alpha (n = 2) with median TTF of 2.1 months (0.9-14.5). Across the entire cohort (n = 27), median OS was 7.9 months (95% CI 4.2-11.2) with estimated 1 year OS rate of 25%. By comparison, a cohort of 67 pts with metastatic ChRCC lacking SF also treated at MSKCC 2002-17 achieved median OS of 38.1 months, (HR 4.6; 95% CI: 2.6-8.3; p < 0.001). In the 6 sChRCC pts with NGS analysis, TP53 (n = 4), PTEN (n = 2) and CHEK2 (n = 2) were the most frequently altered genes. Conclusions: Outcome for pts with metastatic sChRCC was poor in contrast to pts with ChRCC lacking SF. The lack of benefit observed across various classes of systemic agents warrants study of underlying biology and novel agents. [Table: see text]

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P03.12 Complete versus incomplete resection in newly diagnosed Glioblastoma: Impact on functional Outcome

Neuro-Oncology ◽

10.1093/neuonc/noz126.093 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii27-iii27

Author(s):

M A Proescholdt ◽

A Haj ◽

C Doenitz ◽

K Schebesch ◽

A Brawanski

Keyword(s):

Performance Status ◽

Epileptic Seizures ◽

Neurological Impairment ◽

Functional Independence ◽

Complete Resection ◽

Neurological Deficits ◽

Incomplete Resection ◽

Karnofsky Performance Score ◽

Newly Diagnosed ◽

Improvement Rate

Abstract BACKGROUND Surgical resection of (GBM) has three goals: Tissue acquision to establish a histological and molecular diagnosis, prolongation of survival and improvement of neurological impairment. Regarding survival gain, complete resection is superior to incomplete resection. However, no data are available, whether complete resection also has a higher impact on neurological improvement rates compared to incomplete resection. The goal of our study was to compare the reduction of focal neurological deficits and improvement of functional independency in newly diagnosed GBM patients receiving a complete vs. incomplete resection. MATERIAL AND METHODS A cohort of 299 patients (mean age 60.6 year; female/male ratio 124/175) were included. Neurological and functional independence status was measured by the medical research neurological performance status (NPS), the Karnofsky performance score (KPS) and the presence of seizures. Focal neurological impairment regarding hemiparesis, aphasia visual field (VFD) and cranial nerve deficits (CND) was recorded and semi - quantitatively rated pre- and postoperatively as well as at follow up. The extent of resection (EOR) was analyzed using early postoperative MRI scanning and was classified in either complete (CR), incomplete (IR) resection. RESULTS The complete and incomplete resection groups were balanced regarding gender, age, preoperative KPS, MGMT and IDH1 status. Median overall survival (OS) was 14.5 months, showing a significant benefit of complete resection (17.9 vs. 11.5; p = 0.0001). Impaired KPS was detected in 87.9%, epileptic seizures were displayed by 31.4% of all patients, the most frequent focal deficit was aphasia with 25.1%, followed by CND (20.1%) and hemiparesis (17.1%). KPS was improved in 45.6%, seizures were reduced in 91.5%, the highest improvement of focal deficit was achieved in CND (71.7%) the lowest in VFD (44.8%). Complete resection did achieve a higher improvement rate in hemiparesis (79.1% vs. 49.8%; p = 0.03) and seizure activity (97.7% vs. 86.3%; p = 0.04). In all other domains the improvement rates after complete resection were not significantly different to incomplete resection. Finally, complete resection did not show a higher rate of postsurgical worsening rate in any of the domains. CONCLUSION Complete resection is safe and does convey superior improvement rates of epileptic seizures and hemiparesis.

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Performing oncological procedures during COVID-19 outbreak: a picture from an Italian cancer center

Exploration of Targeted Anti-tumor Therapy ◽

10.37349/etat.2021.00058 ◽

2021 ◽

pp. 481-489

Author(s):

Maristella Bungaro ◽

Valentina Bertaglia ◽

Marco Audisio ◽

Elena Parlagreco ◽

Chiara Pisano ◽

...

Keyword(s):

Median Time ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Control Measures ◽

Cancer Center ◽

Nasopharyngeal Swab ◽

Cancer Type ◽

Ecog Performance Status ◽

Optimal Care ◽

Infection Control Measures

Aim: Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rapidly spread around the world, Italy has quickly become one of the most affected countries. Healthcare systems introduced strict infection control measures to ensure optimal care, especially in frail groups such as cancer patients (pts). This study investigated the efficacy of SARS-CoV-2 pre-procedure screening and whether coronavirus disease 2019 (COVID-19) influenced timely diagnosis and therapy. Methods: Data of oncological procedures of pts with confirmed or suspected cancer diagnosis, treated at Oncology Department or coming from Emergency Department of San Luigi Gonzaga Hospital between June 2020 and March 2021 were retrospectively collected. A nasopharyngeal swab (NPS) was performed in outpatients 24/48 h before procedures. Inpatients were tested by NPS before and after hospitalization. Results: Two hundred and twenty-one pts were included in this analysis. Median age was 73 years, males were 58%. Eastern Cooperative Oncology Group (ECOG) Performance Status was 0 or 1 in 88% of pts. The most frequent cancer type was lung cancer (57%). Stages IV were 77%. Two hundred and forty three scheduled procedures were performed with diagnostic (n: 142; 58%), therapeutic (n: 55; 23%), and palliative (n: 46; 19%) intent. One hundred and four and 139 procedures were performed in out- and in-pts, respectively. Of the 234 NPS performed, 10 (4%) were positive. Two pts were infected during hospitalization, 8 in community. Most of them were asymptomatic, while only 2 had mild symptoms. Eight procedures (3%) were postponed, 1 cancelled, while 2 were performed in positive pts. Median time to resolution of the infection was 17 days (11-36). Median delay in the procedures was 25 days (14-55). Five pts started systemic treatment, after a median time of 37.5 days (13-57). Conclusions: SARS-CoV-2 infection led to the postponement of a small, but not negligible percentage of oncological procedures. However, the low infection rate observed suggests that structured screening for COVID-19 is critical for the best management of scheduled procedures during pandemic.

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Presentation, management, and outcome of newly diagnosed glioblastoma in elderly patients

Journal of Neurosurgery ◽

10.3171/2012.10.jns112268 ◽

2013 ◽

Vol 118 (4) ◽

pp. 786-798 ◽

Cited By ~ 53

Author(s):

Shota Tanaka ◽

Fredric B. Meyer ◽

Jan C. Buckner ◽

Joon H. Uhm ◽

Elizabeth S. Yan ◽

...

Keyword(s):

Elderly Patients ◽

Adjuvant Treatment ◽

Karnofsky Performance Status ◽

Combined Therapy ◽

Performance Status ◽

Progression Free Survival ◽

Postoperative Hemorrhage ◽

Neurological Deficits ◽

Newly Diagnosed ◽

Newly Diagnosed Glioblastoma

Object Optimum management for elderly patients with newly diagnosed glioblastoma (GBM) in the temozolomide (TMZ) era is not well defined. The object of this study was to clarify outcomes in this population. Methods The authors retrospectively reviewed 105 consecutive cases involving elderly patients (age ≥ 65 years) with newly diagnosed GBM who were treated at the Mayo Clinic between 2003 and 2008. Results The patients' median age was 74 years (range 66–87 years), and the median Karnofsky Performance Status (KPS) score was 80 (range 40–90). Half of the patients underwent biopsy and half underwent resection. Patients with deep-seated lesions (19 patients [18%]) or multifocal lesions (34 patients [32%]) were more likely to have biopsy than resection (p = 0.0001 and 0.0009, respectively). New persistent neurological deficits developed in 7 patients (6.7%). Postoperative hemorrhage occurred in 6 patients (5.7%), all of whom underwent biopsy. Complete follow-up data regarding adjuvant treatment was available in 84 patients. Forty-one (49%) were treated with chemotherapy (mostly TMZ) and radiation therapy (RT), and 23 (27%) with RT alone. Nineteen (23%) received only palliative care after surgery (more common with biopsy, p = 0.03). Chemotherapy complications occurred in 28.6% (Grade 3 or 4 hematological complications in 11.9%). The median values for progression-free survival (PFS) and overall survival (OS) were 3.5 and 5.5 months. In a multivariate analysis, younger age (p = 0.03, risk ratio [RR] 0.34, 95% CI 0.13–0.89), single lesion (p = 0.02, RR 0.51, 95% CI 0.30–0.89), resection (p = 0.04, RR 0.54, 95% CI 0.31–0.94), and adjuvant treatment (p = 0.0001, RR 0.24, 95% CI 0.11–0.49) were associated with better OS. Only adjuvant treatment was significantly associated with prolonged PFS (p = 0.0007, RR 0.27, 95% CI 0.13–0.57). With combined therapy with resection, RT, and chemotherapy, the median PFS and OS were 8 and 12.5 months, respectively. Conclusions The prognosis for GBM worsens with increasing age in elderly patients. With important risks, resection and adjuvant treatment are associated with prolonged survival. Although selection bias cannot be excluded in this retrospective study, advanced age alone should not necessarily preclude optimal resection followed by adjuvant radiochemotherapy.

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