Journal of Neuro-Oncology

, Volume 43, Issue 2, pp 187–193

Treatment of Malignant Gliomas in the Elderly

  • Jean-Yves Pierga
  • Khé Hoang-Xuan
  • Loïc Feuvret
  • Jean-Marc Simon
  • Philippe Cornu
  • François Baillet
  • Jean-Jacques Mazeron
  • Jean-Yves Delattre
Article

DOI: 10.1023/A:1006262918694

Cite this article as:
Pierga, JY., Hoang-Xuan, K., Feuvret, L. et al. J Neurooncol (1999) 43: 187. doi:10.1023/A:1006262918694

Abstract

The benefit of standard treatment of malignant glioma in older patients is debated. In order to assess the effect of a combination of surgery, radiotherapy and chemotherapy on survival of elderly patients with high grade gliomas, 30 consecutive patients older than 70 years with malignant supratentorial gliomas were studied between 9/93 and 9/96. Median age was 73 years (70–79). The mean Karnofsky performance status (KPS) was 66 (30–100). Patients underwent maximum possible surgery, followed by a course of radiotherapy (45 Gy/25 fractions/5 weeks) with 3 or 4 orthogonal beams and a 2 cm margin around the tumor bed. The administration of chemotherapy was left at the discretion of the responsible physician and 12 patients received reduced dose nitrosourea-based chemotherapy. The overall median survival was 36 weeks. The median time to progression was 26 weeks. Three months after surgery, 26 patients were alive, 5 were in complete response, 2 in partial response and 10 were stabilized. Pre-radiotherapy KPS was the only significant prognostic factor with a median survival of 40 weeks in patients with KPS ≥70 and 25 weeks when KPS was >70 (logrank test, p=0.05). In responding and stable patients (57% of the group) the median KPS was 68 and 66 at 1 and 3 months after the completion of radiotherapy. There was no case of radiotherapy-induced dementia with this regimen. Four out of 12 patients who received chemotherapy, experienced WHO grade 3/4 hematotoxicity.

This study suggest that some patients older than 70 years with KPS ≥70 may benefit from the treatment of malignant gliomas with surgery followed by reduced dose of limited field radiotherapy. Further studies are needed to define the most appropriate dose of radiotherapy and to evaluate further the risk/benefit ratio of a reduced dose chemotherapy in this population.

malignant gliomas elderly radiotherapy chemotherapy 

Copyright information

© Kluwer Academic Publishers 1999

Authors and Affiliations

  • Jean-Yves Pierga
    • 1
  • Khé Hoang-Xuan
    • 2
  • Loïc Feuvret
    • 1
  • Jean-Marc Simon
    • 1
  • Philippe Cornu
    • 3
  • François Baillet
    • 1
  • Jean-Jacques Mazeron
    • 1
  • Jean-Yves Delattre
    • 2
  1. 1.Radiation Oncology DepartmentSalpêtrière HospitalParisFrance
  2. 2.Neurology DepartmentSalpêtrière HospitalParisFrance
  3. 3.Neurosurgery DepartmentSalpêtrière HospitalParisFrance

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