Age-Dependent Impact of Concomitant Radio-Chemotherapy and MGMT Promotor Methylation on PFS and OS in Patients with IDH Wild-Type Glioblastoma: The Real-Life Data

SIMPLE SUMMARY: Nowadays: biological but not chronological age and performance have more influence on decision making by patients with malignant brain tissue tumors. We showed how more aggressive therapy results in the increased life expectancy of older patients with this disease in real life. More than half of all patients with these tumors were older than 65 years of age. Even if survival was shorter than in the younger patients, aggressive radio-chemotherapy after the surgery also provided additional time for seniors. In real life, genetically favorable features of the tumor had a positive influence on survival only if more aggressive therapy was applied. ABSTRACT: Biological but not chronological age plus performance have more impact on decision making in glioblastoma patients. We investigated how progression-free survival (PFS) and overall survival (OS) in older patients with IDH wild-type glioblastoma were influenced by concomitant radio-chemotherapy and MGMT promotor methylation status in real-life settings. In total, 142 out of 273 (52%) evaluated patients were older than 65 years, and 77 (55%) of them received concomitant radio-chemotherapy. In senior patients, the initiation of concomitant radio-chemotherapy was associated with significantly better PFS: 15.3 months (CI95: 11.7–18.9) vs. 7.0 months (CI95: 4.3–9.6; p = 0.002). The favorable influence on PFS was not related to MGMT promotor methylation status as it was in the younger cohort. In seniors, concomitant radio-chemotherapy was related to significantly better OS: 20.0 months (CI95: 14.3–26.7) vs. 4.9 months (CI95: 3.5–6.2), p < 0.001. MGMT promotor methylation was related to a more favorable OS only, if concomitant radio-chemotherapy was initiated. In conclusion, more than half of the glioblastoma cohort was older than 65 years of age. Even if PFS and OS were shorter than in the younger cohort, concomitant radio-chemotherapy provided a survival advantage. In real life, MGMT promotor methylation had a positive impact on OS only if the adjuvant therapy was applied.