Frailty profile precluding standard 6-week TMZ chemoradiation in glioblastoma: KPS <70, E...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-GBM-FRAILTY-AGE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-GBM`
Sources	`SRC-EANO-GBM-2024` `SRC-NCCN-CNS-2025`

Red Flag Origin

Definition	Frailty profile precluding standard 6-week TMZ chemoradiation in glioblastoma: KPS <70, ECOG ≥3, OR (age ≥70 with declining functional status), OR composite frailty (age ≥75 + Charlson ≥3). Routes to hypofractionated RT (15 fractions) ± concurrent TMZ per Perry/CCTG-CE.6 elderly trial, or RT alone, or best supportive care.
Clinical direction	de-escalate
Category	frailty-age

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "kps",
      "threshold": 70
    },
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 70
        },
        {
          "finding": "functional_decline",
          "value": true
        }
      ]
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "comparator": ">=",
          "finding": "charlson_score",
          "threshold": 3
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

Perry CCTG-CE.6 (NEJM 2017) established hypofractionated RT 40 Gy / 15 fx + concurrent TMZ + adjuvant TMZ as standard for elderly (≥65) GBM — OS 9.3 mo vs 7.6 mo for RT alone; benefit largest in MGMT-methylated. KPS <60 / ECOG 4: best supportive care + steroids + anti-epileptics (no survival benefit demonstrated for active cancer treatment in this group). KPS 60-70: hypofractionated RT alone (40 Gy / 15 fx) reasonable. Avoid bevacizumab in elderly unfit (no OS benefit, adds AE).

Used By

No reverse references found in the YAML corpus.