Clinical Investigations
Efficacy of radiotherapy for malignant gliomas in elderly patients

Presented in part at the 1997 ASTRO Meeting, Orlando, FL.
https://doi.org/10.1016/S0360-3016(98)00356-3Get rights and content

Abstract

Purpose: Age above 65 years is a strong negative prognostic factor for survival in patients with malignant gliomas (MG) treated with radiotherapy (RT) and its value has been questioned. We analyzed the effect of RT on the survival of elderly patients with malignant gliomas.

Methods and Materials: We examined 85 consecutive elderly patients with a histological diagnosis of MG. Age ranged from 65 to 81 years (median 70 years). Glioblastoma multiforme (GBM) was diagnosed in 64 patients (75.3%). Surgical treatment included needle biopsy in 32 patients (37.6%). Median postoperative Karnofsky Performance Status (KPS) was 60 (range: 30–100). Survival probability was estimated using Kaplan-Meier method and compared with the log-rank test. Crude and adjusted hazard ratios (HR) were calculated using Cox’s regression models.

Results: Median survival time for all patients was 18.1 weeks. In multivariate analysis, RT was the only independent prognostic variable for survival (HR: 9.1 [95% CI: 4.5–18.7]). Forty-two patients did not start RT mostly due to low KPS (<50). The median survival of the 43 patients who started RT was 45 weeks. In these patients, Cox multivariate analysis indicated that age was independently associated with prolonged survival (HR: 2.85 [95% CI 1.31–6.19]). Median survival of patients age 70 years and younger was 55 weeks compared with 34 weeks for patients older than 70 years.

Conclusions: The overall survival for elderly patients with MG is poor. RT seems to improve survival in patients up to 70 years, but in older patients treated with RT the survival is significantly shorter.

Introduction

Patients with malignant gliomas, glioblastoma multiforme (GBM), and anaplastic astrocytoma (AA) have poor prognosis despite advances in surgery, radiotherapy (RT), and treatment with different chemotherapeutic regimens. Age above 64 years has been demonstrated to be a strong negative prognostic factor for survival 1, 2, 3 and several studies have questioned the usefulness of the present treatments in improving quality of life and survival in elderly patients with malignant gliomas 4, 5, 6. However, the issue of how to treat, or not to treat at all, this group of patients has important social impact. Despite the fact that patients included in malignant glioma clinical trials tend to be younger than 60 years, epidemiological studies show that at least 24% of GBM develop in patients 65 years and older (7) and that the incidence of malignant gliomas has increased in this age population in the last decade 8, 9, 10.

The present study analyzes a series of 85 consecutive patients, 65 years and older, with malignant glioma to ascertain the effect of RT on survival and to identify which of these patients may benefit from receiving the standard treatment of surgery and RT.

Section snippets

Methods and materials

From January 1987 to December 1995, we evaluated 91 consecutive patients from two hospitals in Barcelona (Hospital Clinic and Institut Català d’Oncologia) with the histological diagnosis of malignant glioma who were 65 years and older. Clinical and other relevant information, such as the degree of disability measured by the Karnofsky Performance Status scale (KPS), extent of tumor resection, postoperative complications, and RT treatment were routinely recorded in a data base. All the patients

Results

Although postoperative RT was initially intended for all patients, 42 did not start treatment. The main reason was poor KPS (<50), usually with cognitive dysfunction, either due to the tumor itself (25 patients), or to postoperative complications (12). Nine patients refused RT and in one the reason for not receiving treatment was unknown. Eight patients who started RT did not finish the treatment due to tumor progression. Table 1summarizes the main characteristics of all the patients and just

Discussion

The main finding of the present study is that the overall survival of patients 65 years and older with malignant glioma is poor and that age is an important prognostic factor in the group of patients who receive RT. The low survival of the whole series is in part explained by the fact that only 43 (51%) of patients started RT. This figure is similar to that of previous studies 13, 14. Winger and colleagues observed that only 68% of patients diagnosed with AA started RT emphasizing that the

Acknowledgements

We thank Dr. Josep Dalmau and Dr. Myrna Rosenfeld for their critical review of the manuscript.

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