title: Treating high grade gliomas in the elderly: the end of ageism?
abstract: Introduction Treating high grade gliomas in the elderly is a challenge for multidisciplinary teams. Most studies on this topic exclude patients aged >65 and a Karnofsky Performance Status (KPS) score of <70, a group most likely to have a poor outcome. We undertook this study to analyze the outcomes in a cohort of patients which included such patients. Methods Ours was a retrospective cohort study. About 71 consecutive patients with high grade gliomas, who were seen in the neurooncology clinic in 2004, were included. The case records of these patients were scrutinized for the demographic, clinical data, follow-up and survival. The cohort was divided into two groups; Age > or =65 and age <65 for analysis. The factors influencing survival were analyzed using the Cox's proportional hazards model in each group. Results In the age group > or =65 years, patients treated with a radical resection +/- adjuvant therapy had a lower risk of death (hazard ratio 0.14, 95%CI 0.04-0.51, P = 0.003) when compared to patients undergoing a biopsy +/- adjuvant therapy and palliative treatment. In the group <65 years, the greater the age, greater was the risk of death (hazard ratio 2.05, 95%CI 1.13-3.73, P = 0.01). The median survival was 12 months in the group <65 years and 5 months in age > or =65 years (P = 0.001). In the group > or =65 years, those patients who had radical resection +/- adjuvant treatment had a median survival of 7 months as compared to 3 months in the patients who had biopsy +/- adjuvant treatment (P = 0.003). KPS, presence of co-morbidities, duration of symptoms, location of the lesion and sex were not found to be significant independent predictors of survival in our study. Conclusions Age is an important predictor of survival in younger patients, however in the elderly treatment matters most. Elderly patients undergoing radical surgery +/- adjuvant treatment had a longer median survival as compared to the elderly patients undergoing a biopsy +/- adjuvant treatment. KPS was not found to be a significant independent predictor of survival probably because of underrepresentation of patients with poor KPS. Radical treatment should not be denied to elderly patients who are deemed fit as the outcome is significantly better.
authors.affiliation: Neuro-Oncology Services, Department of Neurosurgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
authors.forename: Nitin
authors.initials: N
authors.lastname: Mukerji
authors.forename: Desiderio
authors.initials: D
authors.lastname: Rodrigues
authors.forename: Gill
authors.initials: G
authors.lastname: Hendry
authors.forename: Peter R C
authors.initials: PR
authors.lastname: Dunlop
authors.forename: Fiona
authors.initials: F
authors.lastname: Warburton
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Kane
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology / Q000628:therapy*; D016009:Chi-Square Distribution; D005260:Female; D005853:Geriatrics; D005910:Glioma / Q000401:mortality / Q000628:therapy*; D006801:Humans; D017567:Karnofsky Performance Status / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011287:Prejudice; D012189:Retrospective Studies; D016019:Survival Analysis