We looked at all patients with GBM aged over 70 over three cancer centres, that was over 300 patients and over five years and we looked at the radiological and clinical information on those patients. We then correlated that information with their presenting complaint at diagnosis, the information from scans they had at diagnosis, specifically looking at whether there was any pressure around the brain in the area of the tumour and also their fitness status, and we use for that an ECOG performance status which is a measure of their fitness and saw if we could correlate all of those features with overall survival.

Does that ECOG have to be calibrated against previous brain activity?

So ECOG performance status is a measure of performance status scored from zero to five, zero being a person who has no restrictions on their activity and as the number increases the patient becomes perhaps more dependent. It’s an objective measure that is used across cancer research and in clinical day-to-day practice that we find a useful objective measure of how fit a patient is, so that’s why we use that.

What did you find?

We found that overall the survival in our cohort of patients was unfortunately very poor with a median of only 3.8 months. When looking further into the data we found that factors predicting for a better overall survival were those patients who had surgery and thereafter the surgery had treatment with either radiotherapy alone, radiotherapy plus chemotherapy, or chemotherapy on its own in the form of temozolomide chemotherapy. We found that factors predicting for a worse overall survival were patients presenting with an ECOG performance status of greater than zero, so those that were less independent that others, those who had on their initial MRI imaging often what we call mass effect, or more than one tumour, what we call multi-focal tumours. Finally, we found that those presenting with a presenting complaint other than seizure had a worse overall survival.

What are the implications of these data?

This data is informing us about the best treatment for GBM in this older age group of patients over 70 which is an under-researched area. We feel that this information along with gathering molecular and pathological data on these patients which is part of our project and something we are doing at the moment and also combining this information with the really comprehensive geriatric assessment that we can use in the clinic. Putting both of these together our aim is to come out with an individually tailored treatment plan for these patients over 70. What we hope to do with all of that information is to improve their quality of life whilst they’re having the treatment and also to improve their overall survival.