title: Glioblastoma in the elderly: Therapeutic dilemmas.
abstract: BACKGROUND
  Glioblastoma (GBM) is commonly diagnosed in patients older than 60 years, but the treatment protocols are mostly based on trials in patients aged up to 70 years. These lead to little consensus and to an absence of protocols regarding the standard treatments. The objective of this study is to analyze the prognostic factors, treatment efficacy, and adverse events in a cohort of elderly patients.
  
  
  METHODS
  A retrospective observational study of all patients aged ≥65 with histologically confirmed GBM followed at Centro Hospitalar S. João between 2005 and 2013. Demographic, clinical, radiographic, treatment, and outcome data were evaluated. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  A total of 126 patients were reviewed. Median progression-free survival was 5 months (95% confidence interval [CI], 4.138 to 5.862 months). Median overall survival (OS) was 8 months (95% CI, 5.950 to 10.050 months). Univariate analysis showed the statistically significant associations between the higher OS and age <70 (P = 0.046), Karnofsky performance status ≥70 (P = 0.001), single lesions (P = 0.007), lesions affecting one lobe (P = 0.007), total resection (P = 0.048), and Charlson age-comorbidity index ≤5. Multivariate analysis identified the completion of 60 Gy radiotherapy and completion of 6 or more cycles of temozolomide chemotherapy as independent prognostic factors positively correlated with increased survival.
  
  
  CONCLUSIONS
  Maximal resection and radiochemotherapy treatment completion are associated with longer OS, and age alone should not preclude elderly patients from receiving surgery and adjuvant treatment. However, only a few patients were able to finish the proposed treatments. Poor performance and high comorbidity index status might compromise the benefit of treatment aggressiveness and must be considered in therapeutic decision.
authors.affiliation: Department of Clinical Neurosciences and Mental Health, Medical Faculty of Porto University, Porto, Portugal.
authors.forename: André F
authors.initials: AF
authors.lastname: Pereira
authors.affiliation: Department of Clinical Neurosciences and Mental Health, Medical Faculty of Porto University, Porto, Portugal ; Department of Neurosurgery, Centro Hospitalar S. João, Porto, Portugal.
authors.forename: Bruno F
authors.initials: BF
authors.lastname: Carvalho
authors.affiliation: Department of Clinical Neurosciences and Mental Health, Medical Faculty of Porto University, Porto, Portugal ; Department of Neurosurgery, Centro Hospitalar S. João, Porto, Portugal.
authors.forename: Rui M
authors.initials: RM
authors.lastname: Vaz
authors.affiliation: Department of Clinical Neurosciences and Mental Health, Medical Faculty of Porto University, Porto, Portugal ; Department of Neurosurgery, Centro Hospitalar S. João, Porto, Portugal.
authors.forename: Paulo J
authors.initials: PJ
authors.lastname: Linhares
keywords: Chemotherapy; elderly; glioblastoma; oncology; radiation therapy; resection