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Background Glioblastoma is associated with fatal outcomes and devastating neurological presentations especially impacting the elderly. Management remains controversial and representation in clinical trials poor. We generated two nomograms and a clinical decision making webtool using real world data. Methods Patients ≥ 60 years of age with histologically confirmed glioblastoma (ICD-O-3 histology codes 9440/3, 9441/3, 9442/3) diagnosed 2005 – 2015 were identified from the BC Cancer Registry (n = 822). 729 patients for which performance status was captured were included in the analysis.. Age, performance and resection status, administration of radiation therapy (RT) and chemotherapy were reviewed. Nomograms predicting 6- and 12-month OS probability were developed using Cox proportional hazards regression internally validated by c-index. A web tool powered by JavaScript was developed to calculate the survival probability. Results Median overall survival (OS) was 6.6 months (95% Confidence Interval (CI) 6-7.2 months). Management involved concurrent chemoradiation (CRT) (34%), RT alone (42%), chemo alone (2.3%). 21% of patients did not receive treatment beyond surgical intervention. Age, performance status, extent of resection, chemotherapy and RT administration were all significant independent predictors of OS. Patients &amp;lt;80 years old who received RT had a significant survival advantage, regardless of extent of resection (HR range from 0.22-0.60, CI 0.15-0.95). A nomogram was constructed from all 729 patients (Harrell’s Concordance Index = 0.78 (CI 0.71-0.84)) with a second nomogram based on subgroup analysis of the 452 patients who underwent RT (Harrell’s Concordance Index = 0.81 (CI 0.70-0.90)). An online calculator based on both nomograms was generated for clinical use. Conclusions Two nomograms and accompanying web tool incorporating commonly captured clinical features were generated based on real-world data to optimize decision making in the clinic.

Optimising management of the elderly patient with glioblastoma – survival prediction online tool based on BC Cancer Registry real world data