title: Management of patients aged >60 years with malignant glioma: good clinical status and radiotherapy determine outcome.
abstract: Many clinical trials have shown that the most important prognostic variable in patients with malignant glioma is advanced age. However, can some patients aged >60 years still have relatively good outcomes with conventional surgical and radiotherapeutic treatment? A previous audit of practice (1983-89) suggested that functional status was an important prognostic variable in the elderly. We have reviewed a further cohort (1989-96) to evaluate changes in practice and outcomes given advances in neuroimaging, neurosurgery and radiotherapy. The major findings in this series of 80 patients aged over 60 years with a histological diagnosis of supratentorial malignant glioma were: (i) There was a relationship between management undertaken and clinical status of the patients (p < 0.01), i.e. patients in good grade generally had tumour debulking and radiotherapy, whilst those in poor grade generally had only biopsy. (ii) There was a significant increase in survival of patients in the second period who received surgical debulking and post-operative radiotherapy (from a median of 23 to 41 weeks (p < 0.05). (iii) It is likely that case selection accounted for much of this improvement since there was a direct relationship between median survival time and good clinical grade using the WHO performance scale. (iv) A shorter radiotherapy course (30 Gy in six fractions) was as efficacious as a conventional course (60 Gy in 30 fractions), and those patients having radiotherapy survived significantly longer than those not having this treatment (p = 0.001). This study has again demonstrated the importance of preoperative clinical grade and radiotherapy treatment in determining outcomes in patients >60 years. To put these data in a societal context a recent prospective multicentre audit of patients with malignant glioma in Scotland, and another audit from our unit, showed that between 24 and 65% of patients aged >60 years, with a CT diagnosis of malignant glioma do not undergo either surgery or radiotherapy. Advanced age per se should not be a bar to interventional treatment in patients aged >60 years with suspected malignant glioma.
authors.affiliation: Edinburgh Centre for Neuro-oncology, Department of Clinical Neurosciences, Western General Hospital, UK. irw@skull.dcn.ed.ac.uk
authors.forename: I R
authors.initials: IR
authors.lastname: Whittle
authors.forename: N
authors.initials: N
authors.lastname: Basu
authors.forename: R
authors.initials: R
authors.lastname: Grant
authors.forename: M
authors.initials: M
authors.lastname: Walker
authors.forename: A
authors.initials: A
authors.lastname: Gregor
mesh_terms: D000367:Age Factors; D000368:Aged; D001706:Biopsy / Q000379:methods; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy; D005910:Glioma / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D016896:Treatment Outcome