title: Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age.
abstract: OBJECTIVE
  The objective of this study was to analyze whether age influences the outcome of patients with glioblastoma and whether elderly patients with glioblastoma can tolerate the same aggressive treatment as younger patients.
  
  
  METHODS
  Data from 361 consecutive patients with newly diagnosed cerebral glioblastoma (2000-2006) who underwent regular follow-up evaluation from initial diagnosis until death were prospectively entered into a database. Patients underwent resection (complete, subtotal, or partial) or biopsy, depending on tumor size, location, and Karnofsky Performance Scale score. Following surgery, all patients underwent adjuvant treatment consisting of radiotherapy, chemotherapy, or combined treatment. Patients older than 65 years of age were defined as elderly (146 total).
  
  
  RESULTS
  Two hundred thirty-four patients underwent tumor resection (complete 26%, subtotal 29%, and partial 45%). One hundred twenty-seven underwent biopsy. Mean patient age was 61 years, and overall survival was 11.6 ± 12.1 months. The overall survival of elderly patients (9.1 ± 11.6 months) was significantly lower than that of younger patients (14.9 ± 16.7 months; p = 0.0001). Stratifying between resection or biopsy, age was a negative prognostic factor in patients undergoing biopsy (4.0 ± 7.1 vs 7.9 ± 8.7 months; p = 0.007), but not in patients undergoing tumor resection (13.0 ± 8.5 vs 13.3 ± 14.5 months; p = 0.86). Survival of elderly patients undergoing complete tumor resection was 17.7 ± 8.1 months.
  
  
  CONCLUSIONS
  In this series of patients with glioblastoma, age was a prognostic factor in patients undergoing biopsy, but not in patients undergoing resection. Tumor location and patient clinical status may prohibit extensive resection, but resection should not be withheld from patients only on the basis of age. In elderly patients with glioblastoma, undergoing resection to the extent feasible, followed by adjuvant therapies, is warranted.
authors.affiliation: Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
authors.forename: Agi
authors.initials: A
authors.lastname: Oszvald
authors.forename: Erdem
authors.initials: E
authors.lastname: Güresir
authors.forename: Matthias
authors.initials: M
authors.lastname: Setzer
authors.forename: Hartmut
authors.initials: H
authors.lastname: Vatter
authors.forename: Christian
authors.initials: C
authors.lastname: Senft
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.forename: Kea
authors.initials: K
authors.lastname: Franz
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001921:Brain / Q000473:pathology* / Q000601:surgery*; D001932:Brain Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000601:surgery / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011287:Prejudice; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult