Overall Management > Evaluations and Comparisons

Abstract

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

Whittle IR, Basu N, Grant R, Walker M, Gregor A

Edinburgh Centre for Neuro-oncology, Department of Clinical Neurosciences, Western General Hospital, UK. irw@skull.dcn.ed.ac.uk

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.

PMID: 12389886 [PubMed - in process]