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Glioblastoma—the consequences of advanced patient age on treatment and survival

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Abstract

Glioblastoma is the most common primary brain tumor. Recent evidence suggests that aggressive treatment is also effective in elderly patients. However, large patient series are missing. The aim of this retrospective study was to determine prognostic factors in a large series (n=345) of elderly patients surgically treated for newly diagnosed glioblastoma (WHO grade IV) at a single institution between 1991 and 2002. U-tests (Mann Whitney), chi-square tests, log-rank tests/Kaplan-Meier plots and Cox regression models were used for statistical analysis. Based on the maximum difference in median survival, a threshold of 60 years was used to separate younger from older patients. In total, 185 patients (53.6%) were over 60 years old. In these individuals, total tumor resection, radiotherapy and reoperation for tumor recurrence were identified as independent prognostic factors. When total surgical resection was combined with radiotherapy and reoperation, Kaplan-Meier analysis revealed a median survival of up to 64 weeks in elderly patients. Our data indicate that total tumor resection, radiotherapy and reoperation should also be considered in selected elderly patients. Age alone should not generally exclude elderly individuals from aggressive treatment.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Schleswig-Holstein Medical Center Campus Kiel, Schittenhelmstr. 10, 24105, Kiel, Germany

    Andreas M. Stark, Janka Held-Feindt & H. Maximilian Mehdorn

  2. Institute for Medical Informatics and Statistics, University of Schleswig-Holstein Medical Center Campus Kiel, Brunswiker Str. 10, 24105, Kiel, Germany

    Jürgen Hedderich

Authors
  1. Andreas M. Stark
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  2. Jürgen Hedderich
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  3. Janka Held-Feindt
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  4. H. Maximilian Mehdorn
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Correspondence to Andreas M. Stark.

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Comments

Gabriele Schackert, Dresden, Germany

The authors address a very important question in the treatment of glioblastoma patients, namely what should be done in patients of an advanced age. Advanced age is known to be a negative prognostic factor for glioblastoma patients and is associated with reduced survival time. The authors analysed 185 glioblastoma patients over 60 years. Their results demonstrated that total tumor resection, radiotherapy and reoperation after tumor recurrence were independent prognostic factors. Subsequent to this treatment concept, the older patients achieved a median survival time of 64 weeks, which is comparable to younger patients. This result is important to know. It should encourage neurosurgeons to offer the complete standard treatment also to older patients. Of course, the biological age and the Karnofsky performance score of the patient have to be considered on an individual basis and will influence treatment decision.

Comments

James T. Rutka, Toronto, Canada

The authors have retrospectively analyzed a large cohort of patients with glioblastoma multiforme in attempts to determine an appropriate threshold age for delivering maximum therapies. They somewhat arbitrarily used a cut-off of age 60 to examine their data. They show that patients at this age can still have favorable responses to treatment when compared to younger patients. Hence, their conclusion is that we should not withhold therapy from “elderly” patients just because of age. This is important as there has been significant absence of study regarding the treatment of elderly patients with malignant brain tumors. The authors have argued cogently for a new look at patients under age 60 for the purposes of offering aggressive therapies in this cohort. It would have been interesting if the authors had run the same analysis on patients who were treated at age 70 and then again on those age 80. Here, there may be risk factors of advancing age that would preclude an aggressive approach to GB. Major medical comorbidities become an issue at these ages when compared to patients who are aged 60 or less. It is probably fair to say that age 60 is no longer considered in the elderly age group. Still, the authors’ points are well taken, and patients age 60 and below will benefit from their aggressive treatment strategies as outlined.

Comments

Jun Yoshida, Nagoya, Japan

This article presents interesting suggestions on the management of malignant glioblastoma in the elderly. The elderly are going to constitute an increasing proportion of patients with glioblastomas in the near future, which prompts us to offer valuable options for treatment of elderly glioblastoma patients. The authors suggest that age alone should not generally exclude elderly patients from aggressive treatment with total resection, radiotherapy and reoperation for tumor recurrence. Although the extent of tumor resection as a prognostic factor, particularly in elderly patients, is still controversial, this article supports standard treatments at most institutions in Japan. For tumor recurrence, we generally advocate the safest possible maximum resection attainable for patients as a way to improve overall survival and quality of life even in the elderly. The goal of treatment should be aggressive tumor removal with preservation of function resulting in a favorable outcome.

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Stark, A.M., Hedderich, J., Held-Feindt, J. et al. Glioblastoma—the consequences of advanced patient age on treatment and survival. Neurosurg Rev 30, 56–62 (2007). https://doi.org/10.1007/s10143-006-0051-7

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  • DOI: https://doi.org/10.1007/s10143-006-0051-7

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