Abstract
Background
Glioblastoma (GBM) is the most life-threatening primary brain tumour. Especially in elderly patients, a poorer outcome is noticeable. Until now, the effectiveness of the conventional active treatment has been controversial. The purpose of this study is to find the optimal treatment for elderly patients with newly diagnosed GBM.
Method
The authors retrospectively reviewed 301 patients who were diagnosed with GBM at a single centre from January 2006 to December 2010. All patients were divided into younger and elderly groups based on the cut-off age of 65 years, and the treatment outcome was analysed.
Results
Of 301 patients, 67 (23.3 %) patients were 65 years old or older, and 234 (77.7 %) patients were younger than 65 years. In the elderly group, 49 patients received surgical resection and 18 patients received biopsy. Forty-seven patients (70.1 %) underwent concomitant chemoradiotherapy (CCRT) and 38 patients (56.7 %) underwent adjuvant temozolomide (TMZ) chemotherapy. The median overall survival (OS) of elderly patients was 12.0 months and the progression-free survival (PFS) was 8.5 months. The median OS of elderly patients who underwent CCRT and adjuvant TMZ chemotherapy increased to 16.2 months. On the multivariate analysis, tumour infiltration (p = 0.005), and resection (p = 0.001) were significant independent prognostic factors in elderly patients. The grade 3 or 4 complication rate was not statistically different between the younger group (n = 22, 9.4 %) and the elderly group (n = 8, 12 %).
Conclusion
Elderly patients diagnosed with GBM had a survival benefit and a low complication rate with the conventional treatment. Therefore, elderly patients should be encouraged to receive the conventional active treatment.
Similar content being viewed by others
References
Brandes AA, Franceschi E, Tosoni A, Benevento F, Scopece L, Mazzocchi V, Bacci A, Agati R, Calbucci F, Ermani M (2009) Temozolomide concomitant and adjuvant to radiotherapy in elderly patients with glioblastoma: correlation with MGMT promoter methylation status. Cancer 115:3512–3518
Brandes AA, Monfardini S (2003) The treatment of elderly patients with high-grade gliomas. Semin Oncol 30:58–62
Brandes AA, Vastola F, Basso U, Berti F, Pinna G, Rotilio A, Gardiman M, Scienza R, Monfardini S, Ermani M (2003) A prospective study on glioblastoma in the elderly. Cancer 97:657–662
Cao JQ, Fisher BJ, Bauman GS, Megyesi JF, Watling CJ, Macdonald DR (2012) Hypofractionated radiotherapy with or without concurrent temozolomide in elderly patients with glioblastoma multiforme: a review of ten-year single institutional experience. J Neurooncol 107:395–405
Chaichana KL, Garzon-Muvdi T, Parker S, Weingart JD, Olivi A, Bennett R, Brem H, Quinones-Hinojosa A (2011) Supratentorial glioblastoma multiforme: the role of surgical resection versus biopsy among older patients. Ann Surg Oncol 18:239–245
Chinot OL, Barrie M, Frauger E, Dufour H, Figarella-Branger D, Palmari J, Braguer D, Hoang-Xuan K, Moktari K, Peragut JC, Martin PM, Grisoli F (2004) Phase II study of temozolomide without radiotherapy in newly diagnosed glioblastoma multiforme in an elderly populations. Cancer 100:2208–2214
Combs SE, Wagner J, Bischof M, Welzel T, Wagner F, Debus J, Schulz-Ertner D (2008) Postoperative treatment of primary glioblastoma multiforme with radiation and concomitant temozolomide in elderly patients. Int J Radiat Oncol Biol Phys 70:987–992
Devaux BC, O’Fallon JR, Kelly PJ (1993) Resection, biopsy, and survival in malignant glial neoplasms. A retrospective study of clinical parameters, therapy, and outcome. J Neurosurg 78:767–775
Fiorica F, Berretta M, Colosimo C, Stefanelli A, Ursino S, Zanet E, Palmucci T, Maugeri D, Malaguarnera M, Palmucci S, Grasso M, Tirelli U, Cartei F (2010) Glioblastoma in elderly patients: safety and efficacy of adjuvant radiotherapy with concomitant temozolomide. Arch Gerontol Geriatr 51:31–35
Gorlia T, van den Bent MJ, Hegi ME, Mirimanoff RO, Weller M, Cairncross JG, Eisenhauer E, Belanger K, Brandes AA, Allgeier A, Lacombe D, Stupp R (2008) Nomograms for predicting survival of patients with newly diagnosed glioblastoma: prognostic factor analysis of EORTC and NCIC trial 26981-22981/CE.3. Lancet Oncol 9:29–38
Iwamoto FM, Cooper AR, Reiner AS, Nayak L, Abrey LE (2009) Glioblastoma in the elderly: the Memorial Sloan-Kettering Cancer Center Experience (1997–2007). Cancer 115:3758–3766
Iwamoto FM, Reiner AS, Panageas KS, Elkin EB, Abrey LE (2008) Patterns of care in elderly glioblastoma patients. Ann Neurol 64:628–634
Joo KM, Kim J, Jin J, Kim M, Seol HJ, Muradov J, Yang H, Choi YL, Park WY, Kong DS, Lee JI, Ko YH, Woo HG, Lee J, Kim S, Nam DH (2013) Patient-specific orthotopic glioblastoma xenograft models recapitulate the histopathology and biology of human glioblastomas in situ. Cell Rep 3:260–273
Keime-Guibert F, Chinot O, Taillandier L, Cartalat-Carel S, Frenay M, Kantor G, Guillamo JS, Jadaud E, Colin P, Bondiau PY, Menei P, Loiseau H, Bernier V, Honnorat J, Barrie M, Mokhtari K, Mazeron JJ, Bissery A, Delattre JY, Association of French-Speaking N-O (2007) Radiotherapy for glioblastoma in the elderly. N Engl J Med 356:1527–1535
Kimple RJ, Grabowski S, Papez M, Collichio F, Ewend MG, Morris DE (2010) Concurrent temozolomide and radiation, a reasonable option for elderly patients with glioblastoma multiforme? Am J Clin Oncol 33:265–270
Kreth FW, Warnke PC, Scheremet R, Ostertag CB (1993) Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme. J Neurosurg 78:762–766
Lamborn KR, Chang SM, Prados MD (2004) Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro Oncol 6:227–235
Laperriere N, O’Callaghan C, Ding K (2008) Rationale and design for a phase III randomized controlled trial in elderly patients with glioblastoma multiforme: NCIC CTG CE. Paper presented at: 13th Biennial Canadian Neuro-Oncology Meeting 16–18 May, 2008; Banff, Alberta, Canada
Lee JH, Jung TY, Jung S, Kim IY, Jang WY, Moon KS, Jeong EH (2013) Performance status during and after radiotherapy plus concomitant and adjuvant temozolomide in elderly patients with glioblastoma multiforme. J Clin Neurosci 20:503–508
Malmström A, Grønberg BH, Marosi C, Stupp R, Frappaz D, Schultz H, Abacioglu U, Tavelin B, Lhermitte B, Hegi ME, Rosell J, Henriksson R (2012) Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol 13:916–926
Minniti G, De Sanctis V, Muni R, Filippone F, Bozzao A, Valeriani M, Osti MF, De Paula U, Lanzetta G, Tombolini V, Maurizi Enrici R (2008) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in elderly patients. J Neurooncol 88:97–103
Minniti G, Lanzetta G, Scaringi C, Caporello P, Salvati M, Arcella A, De Sanctis V, Giangaspero F, Enrici RM (2012) Phase II study of short-course radiotherapy plus concomitant and adjuvant temozolomide in elderly patients with glioblastoma. Int J Radiat Oncol Biol Phys 83:93–99
Minniti G, Salvati M, Arcella A, Buttarelli F, D’Elia A, Lanzetta G, Esposito V, Scarpino S, Maurizi Enrici R, Giangaspero F (2011) Correlation between O6-methylguanine-DNA methyltransferase and survival in elderly patients with glioblastoma treated with radiotherapy plus concomitant and adjuvant temozolomide. J Neurooncol 102:311–316
NCI CTCAE Available from: URL:http://evs.nci.nih.gov/ftp1/CTCAE/About.html. Accessed May, 17, 2010
Piccirilli M, Bistazzoni S, Gagliardi FM, Landi A, Santoro A, Giangaspero F, Salvati M (2006) Treatment of glioblastoma multiforme in elderly patients. Clinico-therapeutic remarks in 22 patients older than 80 years. Tumori 92:98–103
Reifenberger G, Hentschel B, Felsberg J, Schackert G, Simon M, Schnell O, Westphal M, Wick W, Pietsch T, Loeffler M, Weller M, German Glioma N (2012) Predictive impact of MGMT promoter methylation in glioblastoma of the elderly. Int J Cancer 131:1342–1350
Roa W, Brasher PM, Bauman G, Anthes M, Bruera E, Chan A, Fisher B, Fulton D, Gulavita S, Hao C, Husain S, Murtha A, Petruk K, Stewart D, Tai P, Urtasun R, Cairncross JG, Forsyth P (2004) Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol 22:1583–1588
Scott J, Tsai YY, Chinnaiyan P, Yu HH (2011) Effectiveness of radiotherapy for elderly patients with glioblastoma. Int J Radiat Oncol Biol Phys 81:206–210
Scott JG, Bauchet L, Fraum TJ, Nayak L, Cooper AR, Chao ST, Suh JH, Vogelbaum MA, Peereboom DM, Zouaoui S, Mathieu-Daude H, Fabbro-Peray P, Rigau V, Taillandier L, Abrey LE, DeAngelis LM, Shih JH, Iwamoto FM (2012) Recursive partitioning analysis of prognostic factors for glioblastoma patients aged 70 years or older. Cancer 118:5595–5600
Sijben AE, McIntyre JB, Roldan GB, Easaw JC, Yan E, Forsyth PA, Parney IF, Magliocco AM, Bernsen H, Cairncross JG (2008) Toxicity from chemoradiotherapy in older patients with glioblastoma multiforme. J Neurooncol 89:97–103
Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, Ludwin SK, Allgeier A, Fisher B, Belanger K, Hau P, Brandes AA, Gijtenbeek J, Marosi C, Vecht CJ, Mokhtari K, Wesseling P, Villa S, Eisenhauer E, Gorlia T, Weller M, Lacombe D, Cairncross JG, Mirimanoff RO, European Organisation for R, Treatment of Cancer Brain T, Radiation Oncology G, National Cancer Institute of Canada Clinical Trials G (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10:459–466
Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO, European Organisation for R, Treatment of Cancer Brain T, Radiotherapy G, National Cancer Institute of Canada Clinical Trials G (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996
Tanaka S, Meyer FB, Buckner JC, Uhm JH, Yan ES, Parney IF (2013) Presentation, management, and outcome of newly diagnosed glioblastoma in elderly patients. J Neurosurg 118:786–798
Vuorinen V, Hinkka S, Farkkila M, Jaaskelainen J (2003) Debulking or biopsy of malignant glioma in elderly people - a randomised study. Acta Neurochir (Wien) 145:5–10
Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, Degroot J, Wick W, Gilbert MR, Lassman AB, Tsien C, Mikkelsen T, Wong ET, Chamberlain MC, Stupp R, Lamborn KR, Vogelbaum MA, van den Bent MJ, Chang SM (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28:1963–1972
Wick W, Platten M, Meisner C, Felsberg J, Tabatabai G, Simon M, Nikkhah G, Papsdorf K, Steinbach JP, Sabel M, Combs SE, Vesper J, Braun C, Meixensberger J, Ketter R, Mayer-Steinacker R, Reifenberger G, Weller M, Society NOASGoN-oWGoGC (2012) Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Oncol 13:707–715
Acknowledgments
This work was supported by the Global Frontier Project grant (NRF-2012M3A6A-2010-0029781) of National Research Foundation funded by the Ministry of Education, Science and Technology of Korea and by a grant of the Korea Healthcare Technology R&D Project, Ministry for Health and Welfare Affairs (A092255).
Conflict of interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Oh, S.W., Jee, T.K., Kong, DS. et al. Outcome of conventional treatment and prognostic factor in elderly glioblastoma patients. Acta Neurochir 156, 641–651 (2014). https://doi.org/10.1007/s00701-014-2020-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-014-2020-1