title: Prognostic factors and survival study in high-grade glioma in the elderly.
abstract: Background Glioblastoma multiforme (GBM) is the most common and malignant primary brain tumour in adults. Due to the ageing of the population, diagnosis in the elderly is becoming more common. The aim of this study was to analyse different combinations of treatments and to identify preoperative factors, including O6-methylguanine-DNA methyltransferase status, that may be associated with decreased survival among patients older than 70 years. Methods and materials We retrospectively included all patients over 70 years of age, who underwent surgery at the Department of Neurosurgery (HUCA and HUMV) and were diagnosed of GBM by pathological criteria from January 2007 to September 2014. Results Eighty-one patients were analysed, whose mean age was 75 (SD 4) and 48 were male. Karnofsky performance status (KPS) was over 70 in 61 patients and 38.3% presented with motor deficit. Sixty-three patients underwent resection, and 18 had only a diagnostic biopsy. The complication rate was 17.28% and mortality rate was 7.4%. Survival was increased in patients who received radiotherapy (n = 41) or additional chemotherapy (n = 26) (p < 0.001). KPS < 70 was an independent factor associated with low-rate survival. Patients with optimal treatment had a median survival of 8 months compared to patients with suboptimal treatment who had a median survival of 4 months (p < 0.001). Conclusions This study suggests that KPS is the most important preoperative prognostic factor. Maximal safe resection followed by radical radiotherapy and temozolomide might be the optimal treatment of choice since glioblastoma-diagnosed patients over 70 years of age showed a statistically significant survival benefit.
authors.affiliation: a Neurosurgery Department , Hospital Universitario Central De Asturias , Oviedo , Spain ;
authors.forename: Sayoa
authors.initials: S
authors.lastname: Álvarez de Eulate-Beramendi
authors.affiliation: a Neurosurgery Department , Hospital Universitario Central De Asturias , Oviedo , Spain ;
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Álvarez-Vega
authors.affiliation: b Molecular Oncology Department , Hospital Universitario Central De Asturias , Oviedo , Spain ;
authors.forename: Milagros
authors.initials: M
authors.lastname: Balbin
authors.affiliation: b Molecular Oncology Department , Hospital Universitario Central De Asturias , Oviedo , Spain ;
authors.forename: Ana
authors.initials: A
authors.lastname: Sanchez-Pitiot
authors.affiliation: c Banco De tumores - IUOPA , Hospital Universitario Central De Asturias , Oviedo , Spain ;
authors.forename: Aitana
authors.initials: A
authors.lastname: Vallina-Alvarez
authors.affiliation: d Neurosurgery Department , Hospital Universitario Marqués De Valdecilla , Santander , Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Martino-González
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005910:Glioma / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D019635:Neurosurgical Procedures / Q000379:methods; D011379:Prognosis; D016019:Survival Analysis; D000077204:Temozolomide; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Aged; glioblastoma multiforme; radiotherapy; surgery; survival; temozolomide