Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma.

2 April 2008

Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma.

Barnholtz-Sloan JS, Williams VL, Maldonado JL, Shahani D, Stockwell HG, Chamberlain M, Sloan AE.

1 H. Lee Moffitt Cancer Center and Research Institute,, 2 Department of Interdisciplinary Oncology, College of Medicine, and, 4 Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida; and, 3 Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, and, 5 Department of Neurosurgery, University Hospitals–Case Medical Center, Cleveland, Ohio.

Object This study was undertaken to evaluate the association between age at diagnosis, patterns of care, and outcome among elderly individuals with anaplastic astrocytoma (AA) and glioblastoma multiforme (GBM). Methods Using the Surveillance, Epidemiology and End Results database, the authors identified 1753 individuals with primary GBM and 205 individuals with primary AA (diagnosed between June 1991 and December 1999) who were 66 years and older and whose records were linked to Medicare information. To facilitate gathering of prediagnosis comorbidity and postdiagnosis treatment information, only those individuals were included who had the same Medicare coverage for 6 months before and 12 months after diagnosis. The odds of undergoing various combinations of treatments and the associations with outcome were calculated by tumor type and age and adjusted by various predictors. Results Age was not associated with treatment differences in individuals with AA. Very elderly individuals (>/= 75 years old) with GBM were more likely to have biopsy only (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.78-3.59), surgery only (OR 1.47, 95% CI 1.15-1.87), or biopsy and radiation (OR 1.39, 95% CI 1.07-1.82) and were less likely to receive multimodal therapy. Regardless of patient age or lesion histological characteristics, survival was decreased in patients treated with biopsy only. Individuals with GBM who had surgery only or biopsy and radiation had worse outcomes than individuals treated with surgery and radiation. There were no differences in survival by lesion histological characteristics. Very elderly individuals with malignant astrocytomas were more likely to receive limited treatment (most pronounced in individuals with GBM). Survival variation correlated with treatment combinations. Conclusions These findings suggest that in clinical neurooncology patient age is associated with not receiving effective therapies and hence worse prognosis.

Commento Personale: I malati di GBM (glioblastoma) con età superiore ai 65 anni generalmente non vengono curati. Non come dovrebbero, ovvero nella loro totalità di possibilità di trattamenti. Questo per la aggressività con la quale la malattia colpisce le persone anziane. Tuttavia, nel prolungare la sopravvivenza, questo studio ha dimostrato come l’utilizzo di craniotomia (ove possibile) unita a radioterapia offre una maggiore sopravvivenza rispetto ad una sola biopsia, un solo intervento chirurgico o solamente radiazioni. Alcuni studi hanno utilizzato anche la chemioterapia: l’abbinamento del Temodal produce una probabilità di sopravvivenza ad un anno inferiore al 50% con la mediana che si attesta attorno ai dieci mesi in una terapia combinata. Un altro studio sul Temodal e gli anziani è possibile reperirlo qui. L’aspetto che maggiormente aumenta le probabilità di sopravvivenza (più a lungo termine) è legato al KPS del paziente, ovvero al suo stato fisico. Un KPS maggiore di 70 può estendere la sopravvivenza mediana di questa particolare categoria di persone anziane (indicativamente sopra i 65 anni) sino a circa 14 mesi, in linea con le mediane complessive.

Source J Neurosurg. 2008 Apr;108(4):642-648