title: Glioblastoma in the elderly: the impact of advanced age on treatment and survival.
abstract: OBJECTIVE
  To evaluate the effects of combined treatments on the outcome and survival of elderly (≥ 65 years) patients with glioblastoma as compared with younger ones.
  
  
  METHODS
  Fifty consecutive elderly (≥ 65 years) patients (group A) who underwent complete or subtotal (> 80%) resection of brain glioblastoma followed by irradiation and chemotherapy with temozolomide between 2004 and 2009 were retrospectively reviewed and compared with 50 glioblastoma patients aged < 65 years, treated in the same period (group B). Patient sex, tumor location, size and side, combined treatments, reoperation, progression-free survival, and overall survival were compared in the two groups by using the Kaplan-Meyer method.
  
  
  RESULTS
  There were no significant differences between the two groups for tumor location, size and side, and Ki-67 Li. Forty-four of 50 group B patients were treated by the Stupp protocol, whereas all group A patients underwent irradiation and adjuvant temozolomide. Second-line chemotherapy was administrated in 32% of group A and 76% of group B cases, and reoperation was performed in 16% and 36%, respectively. The median survival of the overall series of 100 patients was 15.6 months. Group A patients (≥ 65 years) had a median survival of 14.5 months, significantly lower than group B cases (17 months) (p = 0.02).
  
  
  CONCLUSIONS
  Elderly patients with glioblastoma may benefit from combined treatments, including surgery, radiotherapy, and chemotherapy. Although younger patients do survive longer than older ones, the difference of survival is less significant if several criteria of selection to surgery, such as good Karnofsky performance status (KPS), largely resectable tumor, and no significant comorbidity, are respected.
authors.affiliation: Department of Neurosciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Napoli, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mariniello
authors.affiliation: Department of Neurosciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Napoli, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Peca
authors.affiliation: Department of Biomorphologic and Functional Sciences, Section of Pathology, "Federico II" University School of Medicine, Naples, Italy.
authors.forename: Marialaura Del Basso
authors.initials: Mdel B
authors.lastname: De Caro
authors.affiliation: Department of Neurosciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Napoli, Italy.
authors.forename: Arcangelo
authors.initials: A
authors.lastname: Giamundo
authors.affiliation: Department of Neurosciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Napoli, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Donzelli
authors.affiliation: Department of Neurosciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Napoli, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maiuri
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D003399:Craniotomy; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating