Management of patients aged >60 years with malignant glioma: good clinical status and radiotherapy determine outcome

I R Whittle, N Basu, R Grant, M Walker, A Gregor, Neil Basu

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Abstract

Many clinical trials have shown that the most important prognostic variable in patients with malignant glioma is advanced age. However, can some patients aged >60 years still have relatively good outcomes with conventional surgical and radiotherapeutic treatment? A previous audit of practice (1983-89) suggested that functional status was an important prognostic variable in the elderly. We have reviewed a further cohort (1989-96) to evaluate changes in practice and outcomes given advances in neuroimaging, neurosurgery and radiotherapy. The major findings in this series of 80 patients aged over 60 years with a histological diagnosis of supratentorial malignant glioma were: (i) There was a relationship between management undertaken and clinical status of the patients (p <0.01), i.e. patients in good grade generally had tumour debulking and radiotherapy, whilst those in poor grade generally had only biopsy. (ii) There was a significant increase in survival of patients in the second period who received surgical debulking and post-operative radiotherapy (from a median of 23 to 41 weeks (p <0.05). (iii) It is likely that case selection accounted for much of this improvement since there was a direct relationship between median survival time and good clinical grade using the WHO performance scale. (iv) A shorter radiotherapy course (30 Gy in six fractions) was as efficacious as a conventional course (60 Gy in 30 fractions), and those patients having radiotherapy survived significantly longer than those not having this treatment (p = 0.001). This study has again demonstrated the importance of preoperative clinical grade and radiotherapy treatment in determining outcomes in patients >60 years. To put these data in a societal context a recent prospective multicentre audit of patients with malignant glioma in Scotland, and another audit from our unit, showed that between 24 and 65% of patients aged >60 years, with a CT diagnosis of malignant glioma do not undergo either surgery or radiotherapy. Advanced age per se should not be a bar to interventional treatment in patients aged >60 years with suspected malignant glioma.
Original languageEnglish
Pages (from-to)343-7
Number of pages5
JournalBritish Journal of Neurosurgery
Volume16
Issue number4
Publication statusPublished - 1 Aug 2002

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Keywords

  • Age Factors
  • Aged
  • Biopsy
  • Brain Neoplasms
  • Cohort Studies
  • Female
  • Glioblastoma
  • Glioma
  • Humans
  • Male
  • Middle Aged
  • Preoperative Care
  • Prognosis
  • Treatment Outcome

Cite this

Whittle, I. R., Basu, N., Grant, R., Walker, M., Gregor, A., & Basu, N. (2002). Management of patients aged >60 years with malignant glioma: good clinical status and radiotherapy determine outcome. British Journal of Neurosurgery, 16(4), 343-7.