Skip to main content
SpringerLink
Log in

Treatment outcomes in glioblastoma patients aged 76 years or older: a multicenter retrospective cohort study

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Age is one of the most important prognostic factors in glioblastoma patients, but no standard treatment has been established for elderly patients with this condition. We therefore conducted a retrospective cohort study to evaluate treatment regimens and outcomes in elderly glioblastoma patients. The study population consisted of 79 glioblastoma patients aged ≥76 years (median age 78.0 years; 34 men and 45 women). The median preoperative Karnofsky performance status (KPS) score was 60. Surgical procedures were classified as biopsy (31 patients, 39.2 %), <95 % resection of the tumor (21 patients, 26.9 %), and ≥95 % resection of the tumor (26 patients, 33.3 %). Sixty-seven patients (81.0 %) received radiotherapy and 45 patients (57.0 %) received chemotherapy. The median overall progression-free survival time was 6.8 months, and the median overall survival time was 9.8 months. Patients aged ≥78 years were significantly less likely to receive radiotherapy (p = 0.004). Patients with a postoperative KPS score of ≥60 were significantly more likely to receive maintenance chemotherapy (p = 0.008). Multivariate analyses identified two independent prognostic factors: postoperative KPS score ≥60 (hazard ratio [HR] = 0.531, 95 % confidence interval [CI] 0.315–0.894, p = 0.017) and temozolomide therapy (HR = 0.442, 95 % CI 0.25–0.784, p < 0.001).The findings of this study suggest that postoperative KPS score is an important prognostic factor for glioblastoma patients aged ≥76 years, and that these patients may benefit from temozolomide therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Li J, Wang M, Won M, Shaw EG, Coughlin C, Curran WJ Jr, Mehta MP (2011) Validation and simplification of the radiation therapy oncology group recursive partitioning analysis classification for glioblastoma. Int J Radiat Oncol Biol Phys 81:623–630

    Article  PubMed Central  PubMed  Google Scholar 

  2. Stupp R, Mason WP, Van den Bent MJ, European Organization for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups, National Cancer Institute of Canada Clinical Trials Group et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996

    Article  CAS  PubMed  Google Scholar 

  3. Brandes AA, Vastola F, Basso U, Berti F, Pinna G, Rotilio A, Gardiman M, Scienza R, Monfardini S, Silvio M, Ermani M (2003) A prospective study on glioblastoma in the elderly. Cancer 97:657–662

    Article  PubMed  Google Scholar 

  4. Gállego Pérez-Larraya J, Ducray F, Chinot O et al (2011) Temozolomide in elderly patients with newly diagnosed glioblastoma and poor performance status: an ANOCEF phase II trial. J Clin Oncol 29:3050–3055

    Article  PubMed  Google Scholar 

  5. Laperriere N, Weller M, Stupp R, Perry JR, Brandes AA, Wick W, van den Bent MJ (2012) Optimal management of elderly patients with glioblastoma. Cancer Treat Rev 39(4):350–357

    Article  PubMed  Google Scholar 

  6. Gulati S, Jakola AS, Johannesen TB, Solheim O (2012) Survival and treatment patterns of glioblastoma in the elderly: a population-based study. World Neurosurg 78:518–526

    Article  PubMed  Google Scholar 

  7. Committee of Brain Tumor Registry of Japan (2009) Report of brain tumor registry of Japan (1984–2000), 12th edition. Neurol Med Chir (Tokyo) 49(Suppl):S1–S96

    Google Scholar 

  8. Piccirilli M, Bistazzoni S, Gagliardi FM, Landi A, Santoro A, Giangaspero F, Salvati M (2006) Treatment of glioblastoma multiforme in elderly patients. Clinico-therapeutic remarks in 22 patients older than 80 years. Tumori 92:98–103

    PubMed  Google Scholar 

  9. Macdonald DR, Cascino TL, Schold SC, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280

    CAS  PubMed  Google Scholar 

  10. Kita D, Ciernik IF, Vaccarella S, Franceschi S, Kleihues P, Lütolf UM, Ohgaki H (2009) Age as a predictive factor in glioblastomas: population-based study. Neuroepidemiology 33:17–22

    Article  PubMed  Google Scholar 

  11. Barnholtz-Sloan JS, Williams VL, Maldonado JL, Shahani D, Stockwell HG, Chamberlain M, Sloan AE (2008) Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma. J Neurosurg 108:642–648

    Article  PubMed  Google Scholar 

  12. Scott JG, Suh JH, Elson P et al (2011) Aggressive treatment is appropriate for glioblastoma multiforme patients 70 years old or older: a retrospective review of 206 cases. Neuro Oncol 13:428–436

    Article  PubMed Central  PubMed  Google Scholar 

  13. Balducci M, Fiorentino A, De Bonis P et al (2012) Impact of age and co-morbidities in patients with newly diagnosed glioblastoma: a pooled data analysis of three prospective mono-institutional phase II studies. Med Oncol 29:3478–3483

    Article  PubMed  Google Scholar 

  14. Combs SE, Wagner J, Bischof M, Welzel T, Wagner F, Debus J, Schulz-Ertner D (2008) Postoperative treatment of primary glioblastoma multiforme with radiation and concomitant temozolomide in elderly patients. Int J Radiat Oncol Biol Phys 70:987–992

    Article  PubMed  Google Scholar 

  15. Ewelt C, Goeppert M, Rapp M, Steiger HJ, Stummer W, Sabel M (2011) Glioblastoma multiforme of the elderly: the prognostic effect of resection on survival. J Neurooncol 103:611–618

    Article  PubMed  Google Scholar 

  16. Fiorica F, Berretta M, Colosimo C et al (2010) Glioblastoma in elderly patients: safety and efficacy of adjuvant radiotherapy with concomitant temozolomide. Arch Gerontol Geriatr 51:31–35

    Article  CAS  PubMed  Google Scholar 

  17. Gerstein J, Franz K, Steinbach JP, Seifert V, Fraunholz I, Weiss C, Rödel C (2010) Postoperative radiotherapy and concomitant temozolomide for elderly patients with glioblastoma. Radiother Oncol 97:382–386

    Article  CAS  PubMed  Google Scholar 

  18. Kushnir I, Tzuk-Shina T (2011) Efficacy of treatment for glioblastoma multiforme in elderly patients (65+): a retrospective analysis. Isr Med Assoc J 13:290–294

    PubMed  Google Scholar 

  19. Oszvald A, Güresir E, Setzer M, Vatter H, Senft C, Seifert V, Franz K (2012) Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age. J Neurosurg 116:357–364

    Article  PubMed  Google Scholar 

  20. Stummer W, Nestler U, Stockhammer F et al (2011) Favorable outcome in the elderly cohort treated by concomitant temozolomide radiochemotherapy in a multicentric phase II safety study of 5-ALA. J Neurooncol 103:361–370

    Article  CAS  PubMed  Google Scholar 

  21. Minniti G, De Sanctis V, Muni R et al (2008) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in elderly patients. J Neurooncol 88:97–103

    Article  CAS  PubMed  Google Scholar 

  22. Barker CA, Chang M, Chou JF, Zhang Z, Beal K, Gutin PH, Iwamoto FM (2012) Radiotherapy and concomitant temozolomide may improve survival of elderly patients with glioblastoma. J Neurooncol 109:391–397

    Article  CAS  PubMed  Google Scholar 

  23. Chaichana KL, Chaichana KK, Olivi A, Weingart JD, Bennett R, Brem H, Quinones-Hinojosa A (2011) Surgical outcomes for older patients with glioblastoma multiforme: preoperative factors associated with decreased survival. Clinical article. J Neurosurg 114:587–594

    Article  PubMed  Google Scholar 

  24. Mohan DS, Suh JH, Phan JL, Kupelian PA, Cohen BH, Barnett GH (1998) Outcome in elderly patients undergoing definitive surgery and radiation therapy for supratentorial glioblastoma multiforme at a tertiary care institution. Int J Radiat Oncol Biol Phys 42:981–987

    Article  CAS  PubMed  Google Scholar 

  25. Chaichana KL, Garzon-Muvdi T, Parker S, Weingart JD, Olivi A, Bennett R, Brem H, Quiñones-Hinojosa A (2011) Supratentorial glioblastoma multiforme: the role of surgical resection versus biopsy among older patients. Ann Surg Oncol 18:239–245

    Article  PubMed  Google Scholar 

  26. Chinot OL, Barrie M, Frauger E et al (2004) Phase II study of temozolomide without radiotherapy in newly diagnosed glioblastoma multiforme in an elderly populations. Cancer 100:2208–2214

    Article  CAS  PubMed  Google Scholar 

  27. Fiorica F, Berretta M, Colosimo C et al (2010) Glioblastoma in elderly patients: safety and efficacy of adjuvant radiotherapy with concomitant temozolomide. Arch Gerontol Geriatr 51:31–35

    Article  CAS  PubMed  Google Scholar 

  28. Gállego Pérez-Larraya J, Ducray F, Chinot O et al (2011) Temozolomide in elderly patients with newly diagnosed glioblastoma and poor performance status: an ANOCEF phase II trial. J Clin Oncol 29:3050–3055

    Article  PubMed  Google Scholar 

  29. Hashem SA, Salem A, Al-Rashdan A et al (2012) Radiotherapy with concurrent or sequential temozolomide in elderly patients with glioblastoma multiforme. J Med Imaging Radiat Oncol 56:204–210

    Article  PubMed  Google Scholar 

  30. Malmström A, Grønberg BH, Marosi C, Nordic Clinical Brain Tumour Study Group (NCBTSG) et al (2012) Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol 13:916–926

    Article  PubMed  Google Scholar 

  31. Wick W, Platten M, Meisner C, NOA-08 Study Group of the Neuro-oncology Working Group (NOA) of the German Cancer Society et al (2012) Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Oncol 13:707–715

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to Dr. Haruyasu Fujita, Department of Socio-Environmental Medicine, Public Health Division, Gunma University Graduate School of Medicine, Gunma, Japan, for his advice on the statistical analyses.

Conflict of interest

There are no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-chou, Chuo-ku, Niigata, 951-8566, Japan

    Takeo Uzuka

  2. Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

    Kenichiro Asano & Hiroki Ohkuma

  3. Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan

    Toshio Sasajima & Kazuo Mizoi

  4. Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan

    Kaori Sakurada & Takamasa Kayama

  5. Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan

    Toshihiro Kumabe & Teiji Tominaga

  6. Department of Neurosurgery, Iwate Medical University, Morioka, Japan

    Takaaki Beppu & Kuniaki Ogasawara

  7. Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan

    Masahiro Ichikawa & Kiyoshi Saito

  8. Department of Molecular Cancer Science, Yamagata University School of Medicine, Yamagata, Japan

    Chifumi Kitanaka

  9. Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Japan

    Hiroshi Aoki & Yukihiko Fujii

Authors
  1. Takeo Uzuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenichiro Asano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toshio Sasajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kaori Sakurada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toshihiro Kumabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takaaki Beppu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masahiro Ichikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chifumi Kitanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroshi Aoki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kiyoshi Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kuniaki Ogasawara
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Teiji Tominaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kazuo Mizoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hiroki Ohkuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yukihiko Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Takamasa Kayama
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Tohoku Brain Tumor Study Group

Corresponding author

Correspondence to Takeo Uzuka.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Uzuka, T., Asano, K., Sasajima, T. et al. Treatment outcomes in glioblastoma patients aged 76 years or older: a multicenter retrospective cohort study. J Neurooncol 116, 299–306 (2014). https://doi.org/10.1007/s11060-013-1291-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-013-1291-3

Keywords

Search

Navigation