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

Whittle, I.R., Basu, N. , Grant, R., Walker, M. and Gregor, A. (2002) Management of patients aged ≫60 years with malignant glioma: good clinical status and radiotherapy determine outcome. British Journal of Neurosurgery, 16(4), pp. 343-347. (doi: 10.1080/02688690021000007650) (PMID:12389886)

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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 impor tant prognostic variable in the elderly. We have reviewed a fur ther cohort (1989-96) to evaluate changes in practice and outcomes given advances in neuroimaging, neurosurger y 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 sur vival 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 (30Gy in six fractions) was as efficacious as a conventional course (60Gy 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 deter mining 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 surger y or radiotherapy. Advanced age per se should not be a bar to inter ventional treatment in patients aged >60 years with suspected malignant glioma.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Basu, Professor Neil
Authors: Whittle, I.R., Basu, N., Grant, R., Walker, M., and Gregor, A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:British Journal of Neurosurgery
Publisher:Taylor & Francis
ISSN (Online):1360-046X

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