International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationsEfficacy of radiotherapy for malignant gliomas in elderly patients
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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2012, Cancer Treatment ReviewsCitation Excerpt :An ongoing randomized phase III trial from the EORTC (EORTC 26062-22061) is studying short course RT (15 fractions of 2.66 Gy) with concurrent and adjuvant TMZ (up to 12 months) to assess how well they work compared with short course RT alone in treating patients more than 65 years-old with newly diagnosed glioblastoma.45 The combination of resection and RT provides only a modest benefit in patients aged more than 65 years.8,46 Moreover, RT exposes patients to radiation-induced neurological complications.18
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