Age influences chemotherapy response in astrocytomas.
OBJECTIVE
In patients with cerebral astrocytomas treated with nitrosourea-based chemotherapy, to determine whether age is predictive of response, time to progression, survival, or rate of complications.


METHODS
Retrospective analysis of neuroimaging studies and clinical data.


METHODS
University hospital with a busy neuro-oncology service.


METHODS
One hundred forty-eight patients with pathologically confirmed malignant astrocytomas or recurrent astrocytomas.


RESULTS
Partial response occurred in 39% of patients aged < 40 years, in 17% of those aged 40 to 59, and in only 5% of those aged > or = 60 (p < 0.001). Median time to progression after chemotherapy was 23 weeks in patients aged < 60 and 6 weeks in patients aged > or = 60 (p < 0.001). Median survival after chemotherapy was 43 weeks in patients aged < 60 but only 24 weeks in patients aged > or = 60 (p < 0.001). Differences between age groups in response rate, time to progression, and survival persisted with adjustment for tumor grade. The risk of myelosuppressive complications requiring hospitalization was significantly related to age (p = 0.03); such complications occurred in 35% of patients aged > or = 60 and 16% of patients under 60 years.


CONCLUSIONS
Age is strongly predictive of the likelihood of a response to chemotherapy, time to progression, survival, and risk of myelosuppressive complications. Patients aged > or = 60 have a lower change of benefit and an increased risk of myelosuppressive complications from chemotherapy for astrocytomas compared with younger patients.
Grant
R
R
Department of Neurology, University of Michigan, Ann Arbor, USA.
Liang
B C
BC
Page
M A
MA
Crane
D L
DL
Greenberg
H S
HS
Junck
L
L
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001254:Astrocytoma / Q000188:drug therapy* / Q000401:mortality; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016019:Survival Analysis
D000970:Antineoplastic Agents