title: A prospective study on glioblastoma in the elderly.
abstract: BACKGROUND
  Elderly patients (age > 65 years) with glioblastoma multiforme frequently are excluded from clinical studies, and prospective trials for patients with this age group do not exist to date.
  
  
  METHODS
  The authors conducted a prospective trial in 79 consecutive elderly patients with glioblastoma who underwent surgery and received radiotherapy (59.44 grays in 33 fractions; Group A; n = 24 patients) or received the same radiotherapy plus adjuvant chemotherapy with procarbizine, lomustine, and vincristine (PCV; lomustine 110 mg/m(2) on Day 1, procarbazine 60 mg/m(2) on Days 8-21, and vincristine 1.4 mg/m(2) on Days 8 and 29 every 42 days; Group B; n = 32 patients), or received the same radiotherapy plus adjuvant temozolomide (150 mg/m(2) for 5 days every 28 days; Group C; n = 22 patients).
  
  
  RESULTS
  The median time to disease progression (TTP) and median survival MST were 7.2 months (95% confidence interval [95%CI], 6.34-8.64) and 12.5 months (95%CI, 11.6-14.8), respectively. The TTP was significantly better for Group C compared with Groups A and B (10.7 months vs. 5.3 months and 6.9 months, respectively; P = 0.0002). Karnofsky performance status (KPS) (P < 0.001) and temozolomide (P < 0.001) were the only independent prognostic factors. Overall survival was better in Group C compared with Group A (14.9 months vs. 11.2 months; P = 0.002), but there were no statistical differences found between Groups A and B or between Groups B and C. Only KPS (P < 0.001) was predictive of overall survival, even if temozolomide chemotherapy was very close to the significance level (P = 0.058). Hematologic Grade 3-4 toxicity was higher with the PCV chemotherapy regimen compared with the temozolomide chemotherapy regimen.
  
  
  CONCLUSIONS
  Age alone should not preclude appropriate treatment in elderly patients with good performance status, for whom definitive radiation therapy and adjuvant chemotherapy with temozolomide is advised.
authors.affiliation: Department of Medical Oncology, Azienda Ospedale-Università, Padova, Italy. aabrandes@unipd.it
authors.forename: Alba A
authors.initials: AA
authors.lastname: Brandes
authors.forename: Francesca
authors.initials: F
authors.lastname: Vastola
authors.forename: Umberto
authors.initials: U
authors.lastname: Basso
authors.forename: Franco
authors.initials: F
authors.lastname: Berti
authors.forename: Giampietro
authors.initials: G
authors.lastname: Pinna
authors.forename: Antonino
authors.initials: A
authors.lastname: Rotilio
authors.forename: Marina
authors.initials: M
authors.lastname: Gardiman
authors.forename: Renato
authors.initials: R
authors.lastname: Scienza
authors.forename: Silvio
authors.initials: S
authors.lastname: Monfardini
authors.forename: Mario
authors.initials: M
authors.lastname: Ermani
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000628:therapy*; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D005909:Glioblastoma / Q000628:therapy*; D006801:Humans; D008130:Lomustine / Q000008:administration & dosage; D008297:Male; D019635:Neurosurgical Procedures; D011344:Procarbazine / Q000008:administration & dosage; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D000077204:Temozolomide; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D011344:Procarbazine; D014750:Vincristine; D008130:Lomustine; D003606:Dacarbazine; D000077204:Temozolomide