Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age

Clinical article

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Object

The objective of this study was to analyze whether age influences the outcome of patients with glioblastoma and whether elderly patients with glioblastoma can tolerate the same aggressive treatment as younger patients.

Methods

Data from 361 consecutive patients with newly diagnosed cerebral glioblastoma (2000–2006) who underwent regular follow-up evaluation from initial diagnosis until death were prospectively entered into a database. Patients underwent resection (complete, subtotal, or partial) or biopsy, depending on tumor size, location, and Karnofsky Performance Scale score. Following surgery, all patients underwent adjuvant treatment consisting of radiotherapy, chemotherapy, or combined treatment. Patients older than 65 years of age were defined as elderly (146 total).

Results

Two hundred thirty-four patients underwent tumor resection (complete 26%, subtotal 29%, and partial 45%). One hundred twenty-seven underwent biopsy. Mean patient age was 61 years, and overall survival was 11.6 ± 12.1 months. The overall survival of elderly patients (9.1 ± 11.6 months) was significantly lower than that of younger patients (14.9 ± 16.7 months; p = 0.0001). Stratifying between resection or biopsy, age was a negative prognostic factor in patients undergoing biopsy (4.0 ± 7.1 vs 7.9 ± 8.7 months; p = 0.007), but not in patients undergoing tumor resection (13.0 ± 8.5 vs 13.3 ± 14.5 months; p = 0.86). Survival of elderly patients undergoing complete tumor resection was 17.7 ± 8.1 months.

Conclusions

In this series of patients with glioblastoma, age was a prognostic factor in patients undergoing biopsy, but not in patients undergoing resection. Tumor location and patient clinical status may prohibit extensive resection, but resection should not be withheld from patients only on the basis of age. In elderly patients with glioblastoma, undergoing resection to the extent feasible, followed by adjuvant therapies, is warranted.

Abbreviations used in this paper: HR = hazard ratio; KPS = Karnofsky Performance Scale; PFS = progression-free survival.

Article Information

Address correspondence to: Ági Oszvald, M.D., Department of Neurosurgery, Johann Wolfgang Goethe-University Frankfurt am Main, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany. email: Oszvald@em.uni-frankfurt.de.

Please include this information when citing this paper: published online September 23, 2011; DOI: 10.3171/2011.8.JNS102114.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Graphs of PFS in patients with glioblastoma. A: Comparison of the elderly and younger groups. B: Comparison of the age groups undergoing tumor resection. C: Comparison of the age groups undergoing biopsy.

  • View in gallery

    Graphs of overall survival in patients with glioblastoma. A: Comparison of the elderly and younger groups. B: Comparison of the age groups undergoing tumor resection. C: Comparison of the age groups undergoing biopsy.

  • View in gallery

    Graph of overall survival in patients with glioblastoma stratified according to the extent of resection. The two age groups are compared according to complete (A), subtotal (B), and partial resection (C).

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