title: Post-operative management of primary glioblastoma multiforme in patients over 60 years of age.
abstract: OBJECTIVE
  Optimal treatment for elderly patients with glioblastoma multiforme is not well defined. We evaluated the efficacy of post-operative radiotherapy with or without concomitant and/or adjuvant temozolomide in patient, aged > or = 60 years to assess survival and identify prognostic factors of survival.
  
  
  METHODS
  A retrospective analysis of overall survival and progression-free survival in patients with newly diagnosed glioblastoma multiforme aged > or = 60 years treated with post-operative radiotherapy with or without temozolomide chemotherapy was conducted at our institutions. Prognostic factors were determined by univariate and multivariate analyses.
  
  
  RESULTS
  Of 75 study participants (54.7% male; median age at first diagnosis, 65.1 years), 29 (38.7%) underwent gross total resection, whereas others underwent partial resection or biopsy only. All but 1 patient received radiotherapy. Twenty patients received concomitant temozolomic e only. Adjuvant temozolomide (1-50 cycles) was administered in 42 patients; 16 received > or = 6 cycles. Median overall survival was 10.3 months. One- and 2-year overall survival rates were 42.6% and 6.7%, respectively. Median progression-free survival was 4.1 months. Radiochemotherapy was generally well tolerated. Median overall survival was 15.3 and 29.6 months for patients who received 6-12 cycles and >12 cycles of adjuvant temozolomide, respectively. There were no significant differences in overall survival between age groups (60-64, 65-69, and > or = 70 years). Adjuvant temozolomide, Karnofsky performance status > or = 70, and additional surgery after progression were significant prognostic factors of longer overall survival (p<0.05).
  
  
  CONCLUSIONS
  Radiochemotherapy, including > or = 6 cycles of adjuvant temozolomide, was safe and prolonged survival of glioblastoma patients aged > or = 60 years. Aggressive therapy should not be withheld from patients aged > or = 60 years with good performance status because of age.
authors.affiliation: University of Debrecen, Division of Geriatrics, 3rd Department of Internal Medicine, Debrecen. daroczi.borbala@yahoo.com
authors.forename: Borbála
authors.initials: B
authors.lastname: Daróczi
authors.affiliation: University of Szeged, Department of Oncotherapy, Szeged.
authors.forename: Erika
authors.initials: E
authors.lastname: Szántó
authors.affiliation: University of Debrecen, Department of Oncology, Debrecen.
authors.forename: Judit
authors.initials: J
authors.lastname: Tóth
authors.affiliation: University of Szeged, Department of Neurosurgery, Szeged.
authors.forename: Pál
authors.initials: P
authors.lastname: Barzó
authors.affiliation: University of Debrecen, Department of Neurosurgery, Debrecen.
authors.forename: László
authors.initials: L
authors.lastname: Bognár
authors.affiliation: University of Debrecen, Division of Geriatrics, 3rd Department of Internal Medicine, Debrecen.
authors.forename: Gyula
authors.initials: G
authors.lastname: Bakó
authors.affiliation: University of Debrecen, Department of Oncology, Debrecen.
authors.forename: János
authors.initials: J
authors.lastname: Szántó
authors.affiliation: University of Szeged, Department of Oncotherapy, Szeged.
authors.forename: Petra
authors.initials: P
authors.lastname: Mózes
authors.affiliation: University of Szeged, Department of Oncotherapy, Szeged.
authors.forename: Katalin
authors.initials: K
authors.lastname: Hideghéty
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D006814:Hungary; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D000077204:Temozolomide; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide