Presentation, management, and outcome of newly diagnosed glioblastoma in elderly patients.

OBJECT Optimum management for elderly patients with newly diagnosed glioblastoma (GBM) in the temozolomide (TMZ) era is not well defined. The object of this study was to clarify outcomes in this population. METHODS The authors retrospectively reviewed 105 consecutive cases involving elderly patients (age ≥ 65 years) with newly diagnosed GBM who were treated at the Mayo Clinic between 2003 and 2008. RESULTS The patients' median age was 74 years (range 66-87 years), and the median Karnofsky Performance Status (KPS) score was 80 (range 40-90). Half of the patients underwent biopsy and half underwent resection. Patients with deep-seated lesions (19 patients [18%]) or multifocal lesions (34 patients [32%]) were more likely to have biopsy than resection (p = 0.0001 and 0.0009, respectively). New persistent neurological deficits developed in 7 patients (6.7%). Postoperative hemorrhage occurred in 6 patients (5.7%), all of whom underwent biopsy. Complete follow-up data regarding adjuvant treatment was available in 84 patients. Forty-one (49%) were treated with chemotherapy (mostly TMZ) and radiation therapy (RT), and 23 (27%) with RT alone. Nineteen (23%) received only palliative care after surgery (more common with biopsy, p = 0.03). Chemotherapy complications occurred in 28.6% (Grade 3 or 4 hematological complications in 11.9%). The median values for progression-free survival (PFS) and overall survival (OS) were 3.5 and 5.5 months. In a multivariate analysis, younger age (p = 0.03, risk ratio [RR] 0.34, 95% CI 0.13-0.89), single lesion (p = 0.02, RR 0.51, 95% CI 0.30-0.89), resection (p = 0.04, RR 0.54, 95% CI 0.31-0.94), and adjuvant treatment (p = 0.0001, RR 0.24, 95% CI 0.11-0.49) were associated with better OS. Only adjuvant treatment was significantly associated with prolonged PFS (p = 0.0007, RR 0.27, 95% CI 0.13-0.57). With combined therapy with resection, RT, and chemotherapy, the median PFS and OS were 8 and 12.5 months, respectively. CONCLUSIONS The prognosis for GBM worsens with increasing age in elderly patients. With important risks, resection and adjuvant treatment are associated with prolonged survival. Although selection bias cannot be excluded in this retrospective study, advanced age alone should not necessarily preclude optimal resection followed by adjuvant radiochemotherapy.

[1]  K. Franz,et al.  Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age. , 2012, Journal of neurosurgery.

[2]  Samuel T Chao,et al.  Aggressive treatment is appropriate for glioblastoma multiforme patients 70 years old or older: a retrospective review of 206 cases. , 2011, Neuro-oncology.

[3]  A. Olivi,et al.  Surgical outcomes for older patients with glioblastoma multiforme: preoperative factors associated with decreased survival. Clinical article. , 2011, Journal of neurosurgery.

[4]  U. Tirelli,et al.  Glioblastoma in elderly patients: safety and efficacy of adjuvant radiotherapy with concomitant temozolomide. , 2010, Archives of gerontology and geriatrics.

[5]  Steven Piantadosi,et al.  Survival of Patients with Newly Diagnosed Glioblastoma Treated with Radiation and Temozolomide in Research Studies in the United States , 2010, Clinical Cancer Research.

[6]  Alfredo Quinones-Hinojosa,et al.  ASSOCIATION OF SURGICALLY ACQUIRED MOTOR AND LANGUAGE DEFICITS ON OVERALL SURVIVAL AFTER RESECTION OF GLIOBLASTOMA MULTIFORME , 2009, Neurosurgery.

[7]  A. Reiner,et al.  Glioblastoma in the elderly , 2009, Cancer.

[8]  A. Brandes,et al.  Temozolomide concomitant and adjuvant to radiotherapy in elderly patients with glioblastoma , 2009, Cancer.

[9]  Katherine S Panageas,et al.  Patterns of care in elderly glioblastoma patients , 2008, Annals of neurology.

[10]  G. Cairncross,et al.  Glioblastoma in the elderly: An age‐old problem , 2008, Annals of neurology.

[11]  J. Cairncross,et al.  Toxicity from chemoradiotherapy in older patients with glioblastoma multiforme , 2008, Journal of Neuro-Oncology.

[12]  M. Berger,et al.  GLIOMA EXTENT OF RESECTION AND ITS IMPACT ON PATIENT OUTCOME , 2008, Neurosurgery.

[13]  A. Sloan,et al.  Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma. , 2008, Journal of neurosurgery.

[14]  J. Debus,et al.  Postoperative treatment of primary glioblastoma multiforme with radiation and concomitant temozolomide in elderly patients. , 2008, International journal of radiation oncology, biology, physics.

[15]  V. Tombolini,et al.  Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in elderly patients , 2008, Journal of Neuro-Oncology.

[16]  Luc Taillandier,et al.  Radiotherapy for glioblastoma in the elderly. , 2007, The New England journal of medicine.

[17]  M. Papadopoulos,et al.  Survival of patients with glioblastoma multiforme has not improved between 1993 and 2004: analysis of 625 cases , 2007, British journal of neurosurgery.

[18]  R. Mirimanoff,et al.  Radiotherapy and temozolomide for newly diagnosed glioblastoma: recursive partitioning analysis of the EORTC 26981/22981-NCIC CE3 phase III randomized trial. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[19]  F. Zanella,et al.  Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. , 2006, The Lancet. Oncology.

[20]  R. Arusell,et al.  Prospective Study of Quality of Life in Adults with Newly Diagnosed High-grade Gliomas , 2006, Journal of Neuro-Oncology.

[21]  Martin J. van den Bent,et al.  Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. , 2005, The New England journal of medicine.

[22]  J. Tilgner,et al.  Validation of Intraoperative Diagnoses Using Smear Preparations from Stereotactic Brain Biopsies: Intraoperative versus Final Diagnosis—Influence of Clinical Factors , 2005, Neurosurgery.

[23]  Susan M. Chang,et al.  Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. , 2004, Neuro-oncology.

[24]  E. Bruera,et al.  Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[25]  D. Louis,et al.  Age-Dependent Prognostic Effects of Genetic Alterations in Glioblastoma , 2004, Clinical Cancer Research.

[26]  Jan C Buckner,et al.  Factors influencing survival in high-grade gliomas. , 2003, Seminars in oncology.

[27]  A. Brandes,et al.  The treatment of elderly patients with high-grade gliomas. , 2003, Seminars in oncology.

[28]  Anthony Asher,et al.  Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project. , 2003, Journal of neurosurgery.

[29]  Wei Huang,et al.  Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. , 2003, Journal of neurosurgery.

[30]  A. Brandes,et al.  A prospective study on glioblastoma in the elderly , 2003, Cancer.

[31]  M. Berger,et al.  Epidemiology of primary brain tumors: current concepts and review of the literature. , 2002, Neuro-oncology.

[32]  N. Laperriere,et al.  Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review. , 2002, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[33]  L. Stewart,et al.  Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials , 2002, The Lancet.

[34]  Z L Gokaslan,et al.  A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. , 2001, Journal of neurosurgery.

[35]  G. Barnett,et al.  Outcome in elderly patients undergoing definitive surgery and radiation therapy for supratentorial glioblastoma multiforme at a tertiary care institution. , 1998, International journal of radiation oncology, biology, physics.

[36]  L. Deangelis,et al.  Malignant glioma: Who benefits from adjuvant chemotherapy? , 1998, Annals of neurology.

[37]  K R Hess,et al.  Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. , 1998, Neurosurgery.

[38]  O. Witte,et al.  Quantitative imaging study of extent of surgical resection and prognosis of malignant astrocytomas. , 1997, Neurosurgery.

[39]  Kiyoshi Sato,et al.  Prognostic implications of the extent of surgical resection in patients with intracranial malignant gliomas , 1995, Cancer.

[40]  M. Bernstein,et al.  Complications of CT-guided stereotactic biopsy of intra-axial brain lesions. , 1994, Journal of neurosurgery.

[41]  P J Kelly,et al.  Resection, biopsy, and survival in malignant glial neoplasms. A retrospective study of clinical parameters, therapy, and outcome. , 1993, Journal of neurosurgery.

[42]  P. Warnke,et al.  Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme. , 1993, Journal of neurosurgery.

[43]  H. Fine,et al.  Meta‐analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults , 1993, Cancer.

[44]  Charles B. Wilson,et al.  AGE-RELATED CHEMOSENSITIVITY OF STEM CELLS FROM HUMAN MALIGNANT BRAIN TUMOURS , 1982, The Lancet.

[45]  G. Maira,et al.  Glioblastoma Multiforme in the Elderly: A Therapeutic Challenge , 2005, Journal of Neuro-Oncology.

[46]  W. Sauerbrei,et al.  Multivariate Analysis of Prognostic Factors in Patients with Glioblastoma , 2003, Strahlentherapie und Onkologie.

[47]  S. Paek,et al.  Stereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment , 2003, Acta Neurochirurgica.

[48]  D. Nelson,et al.  Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials. , 1993, International journal of radiation oncology, biology, physics.