title: Treatment results and outcome in elderly patients with glioblastoma multiforme--a retrospective single institution analysis.
abstract: OBJECTIVE
  Although glioblastoma multiforme is more common in patients older than 65 years, the elderly population is often excluded from clinical studies. Decision making in this subgroup can be challenging due to the lack of evidence for different neurosurgical and adjuvant treatment strategies.
  
  
  METHODS
  In this retrospective study, we evaluated clinical, treatment and survival data of 124 consecutive patients over 65 years of age with supratentorial glioblastoma multiforme.
  
  
  RESULTS
  Median OS was 6.0 months (std. error 0.783, 95% CI 4.456-7.535). Mean OS was 9.7 months (std. error 0.830, 95% CI 8.073-11.327). In univariate regression analysis, low KPS was of negative prognostic value (p < 0.006 for KPS ≤ 80), while greater advanced age did not have any impact on survival (p = 0.591 for differences between groups). Gross total resection and subtotal resection led to significantly improved overall survival (median 15.0 and 11.0 months; p < 0.02) compared to partial resection or biopsy (both 4.0 months), but complications were more common in subtotal and partial resections. The last observation did not reach statistical significance (p = 0.06). Combinations of irradiation and Temozolomide chemotherapy proved to be more effective than other adjuvant therapies. Extent of resection (gross total resection vs. all others) and form of adjuvant treatment were the only factors of independent prognostic value in multivariate analysis (p = 0.031 and p < 0.001, respectively).
  
  
  CONCLUSIONS
  It appears that more aggressive treatment regimens can lead to longer overall survival in elderly glioblastoma multiforme patients. Gross total resection should be offered whenever safely possible; otherwise, biopsy may be preferred. Non-surgical treatment should consist of postoperative radiotherapy and concomitant and/or adjuvant chemotherapy. Possibly higher rates of hematological side effects in concomitant chemotherapy need to be further investigated.
authors.affiliation: Department of Neurosurgery, Medical University of Graz, Graz, Austria. Electronic address: Markus.Hoffermann@medunigraz.at.
authors.forename: Markus
authors.initials: M
authors.lastname: Hoffermann
authors.affiliation: Department of Neurosurgery, Medical University of Graz, Graz, Austria.
authors.forename: Lukas
authors.initials: L
authors.lastname: Bruckmann
authors.affiliation: Department of Neurosurgery, Medical University of Graz, Graz, Austria.
authors.forename: Ali
authors.initials: A
authors.lastname: Kariem Mahdy
authors.affiliation: Institute of Pathology, Medical University of Graz, Graz, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Asslaber
authors.affiliation: Department of Neurology, Medical University of Graz, Graz, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Payer
authors.affiliation: Department of Neurosurgery, Medical University of Graz, Graz, Austria.
authors.forename: Gord
authors.initials: G
authors.lastname: von Campe
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D060787:Neoplasm Grading; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D000077204:Temozolomide; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Elderly; Extent of resection; Glioblastoma; Malignant Primary Brain Tumors; Temozolomide