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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2018; 37(04): 297-303
DOI: 10.1055/s-0038-1675364
Original Article | Artigo Original
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Survival Analysis in Elderly Patients with Glioblastomas: The Influence of Clinical Status, Tumor and Surgical Features

Análise de sobrevivência em pacientes idosos com glioblastomas: influência de status clínico, aspectos oncológicos e cirúrgicos
Ulysses Oliveira Sousa
1   Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
,
Matheus Fernandes Oliveira
1   Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
,
Lindolfo Carlos Heringer
1   Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
,
Ricardo Vieira Botelho
1   Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
,
José Marcus Rotta
1   Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

19. Mai 2018

31. August 2018

Publikationsdatum:
06. November 2018 (online)

   Lizenzen und Reprints

Abstract

Introduction Glioblastomas are malignant neoplasms, notorious for their poor prognosis. We have conducted a survival analysis in a sample of elderly patients with glioblastomas.

Methods The sample of the present study consisted of elderly patients consecutively admitted from January 2014 to January 2016 (24 months) at the Hospital do Servidor Público Estadual de São Paulo. We have evaluated the impact of age, Karnofsky scale (KS) score, tumor location, and occurrence of perioperative complications.

Results A total of 42 patients were analyzed. Of these, 23 (54.7%) were men, and 19 (45.3%) were women. Patients > 60 years old, with low KS score, deep-seated tumors, and those with perioperative complications had worst outcomes.

Discussion and conclusion Surgery, perioperative chemotherapy and radiotherapy add survival time and quality of life to these patients. In patients with low KS score, isolated radiotherapy and/or chemotherapy might be adequate. Decreasing perioperative complications is essential to adequately deliver adjuvant therapy in elderly patients.

Resumo

Introdução Os glioblastomas são neoplasias malignas, notórios por seu mau prognóstico. Realizamos uma análise de sobrevivência em uma amostra de pacientes idosos com glioblastomas.

Métodos A amostra consistiu de pacientes idosos admitidos consecutivamente de janeiro de 2014 a janeiro de 2016 (24 meses) no Hospital do Servidor Público Estadual de São Paulo. Avaliamos o impacto da idade, da pontuação na escala de Karnofsky (KS, na sigla em inglês), da localização do tumor e da ocorrência de complicações pós-operatórias.

Resultados Um total de 42 pacientes foram analisados, dos quais 23 (54.7%) eram homens e 19 (45.3%) eram mulheres. Pacientes com idade > 60 anos, com uma pontuação KS baixa, tumores profundos e aqueles com complicações pós-operatórias apresentaram os piores resultados.

Discussão e Conclusão A cirurgia, quimioterapia e radioterapia aumentam a sobrevida e a qualidade de vida desses pacientes. Em pacientes com uma pontuação KS baixa, a radioterapia isolada e/ou quimioterapia podem ser adequadas. A redução das complicações perioperatórias é essencial para permitir a realização adequada do tratamento adjuvante em pacientes idosos.

Keywords

neoplasms - glioblastoma - prognosis

Palavras-chave

neoplasias - glioblastoma - prognóstico
 

  • References

  • 1 Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. Cancer 1997; 80 (07) 1273-1283
    CrossrefPubMedGoogle Scholar
  • 2 Paszat L, Laperriere N, Groome P, Schulze K, Mackillop W, Holowaty E. A population-based study of glioblastoma multiforme. Int J Radiat Oncol Biol Phys 2001; 51 (01) 100-107
    PubMedGoogle Scholar
  • 3 Scott J, Tsai YY, Chinnaiyan P, Yu HH. Effectiveness of radiotherapy for elderly patients with glioblastoma. Int J Radiat Oncol Biol Phys 2011; 81 (01) 206-210
    CrossrefPubMedGoogle Scholar
  • 4 Chaichana KL, Chaichana KK, Olivi A. , et al. Surgical outcomes for older patients with glioblastoma multiforme: preoperative factors associated with decreased survival. Clinical article. J Neurosurg 2011; 114 (03) 587-594
    CrossrefPubMedGoogle Scholar
  • 5 Ewelt C, Goeppert M, Rapp M, Steiger HJ, Stummer W, Sabel M. Glioblastoma multiforme of the elderly: the prognostic effect of resection on survival. J Neurooncol 2011; 103 (03) 611-618
    CrossrefPubMedGoogle Scholar
  • 6 Park HK, Koh YC, Song SW. The clinico-oncologic outcomes of elderly patients with glioblastoma after surgical resection followed by concomitant chemo-radiotherapy. Brain Tumor Res Treat 2014; 2 (02) 69-75
    CrossrefPubMedGoogle Scholar
  • 7 Roa W, Brasher PM, Bauman G. , et al. Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol 2004; 22 (09) 1583-1588
    CrossrefPubMedGoogle Scholar
  • 8 Lutterbach J, Ostertag C. What is the appropriate radiotherapy protocol for older patients with newly diagnosed glioblastoma?. J Clin Oncol 2005; 23 (12) 2869-2870
    CrossrefPubMedGoogle Scholar
  • 9 Baker SD, Grochow LB. Pharmacology of cancer chemotherapy in the older person. Clin Geriatr Med 1997; 13 (01) 169-183
    PubMedGoogle Scholar
  • 10 Dinnes J, Cave C, Huang S, Milne R. A rapid and systematic review of the effectiveness of temozolomide for the treatment of recurrent malignant glioma. Br J Cancer 2002; 86 (04) 501-505
    CrossrefPubMedGoogle Scholar
  • 11 Stewart LA. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet 2002; 359 (9311): 1011-1018
    CrossrefPubMedGoogle Scholar
  • 12 Yin AA, Zhang LH, Cheng JX. , et al. Radiotherapy plus concurrent or sequential temozolomide for glioblastoma in the elderly: a meta-analysis. PLoS One 2013; 8 (09) e74242
    CrossrefPubMedGoogle Scholar
  • 13 Fiorica F, Berretta M, Colosimo C. , et al. Glioblastoma in elderly patients: safety and efficacy of adjuvant radiotherapy with concomitant temozolomide. Arch Gerontol Geriatr 2010; 51 (01) 31-35
    CrossrefPubMedGoogle Scholar
  • 14 Gerstein J, Franz K, Steinbach JP. , et al. Postoperative radiotherapy and concomitant temozolomide for elderly patients with glioblastoma. Radiother Oncol 2010; 97 (03) 382-386
    CrossrefPubMedGoogle Scholar
  • 15 Minniti G, Lanzetta G, Scaringi C. , et al. Phase II study of short-course radiotherapy plus concomitant and adjuvant temozolomide in elderly patients with glioblastoma. Int J Radiat Oncol Biol Phys 2012; 83 (01) 93-99
    CrossrefPubMedGoogle Scholar
  • 16 Stupp R, Hegi ME, Mason WP. , et al; European Organisation for Research and Treatment of Cancer Brain Tumour and Radiation Oncology Groups; National Cancer Institute of Canada Clinical Trials Group. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009; 10 (05) 459-466
    CrossrefPubMedGoogle Scholar
  • 17 Wick W, Platten M, Meisner C. , et al; NOA-08 Study Group of Neuro-oncology Working Group (NOA) of German Cancer Society. Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Oncol 2012; 13 (07) 707-715
    CrossrefPubMedGoogle Scholar
  • 18 Malmström A, Grønberg BH, Marosi C. , et al; Nordic Clinical Brain Tumour Study Group (NCBTSG). 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 2012; 13 (09) 916-926
    CrossrefPubMedGoogle Scholar
  • 19 Álvarez de Eulate-Beramendi S, Álvarez-Vega MA, Balbin M, Sanchez-Pitiot A, Vallina-Alvarez A, Martino-González J. Prognostic factors and survival study in high-grade glioma in the elderly. Br J Neurosurg 2016; 30 (03) 330-336
    CrossrefPubMedGoogle Scholar
  • 20 Almenawer SA, Badhiwala JH, Alhazzani W. , et al. Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis. Neuro-oncol 2015; 17 (06) 868-881
    PubMedGoogle Scholar
  • 21 Ferguson M, Rodrigues G, Cao J, Bauman G. Management of high-grade gliomas in the elderly. Semin Radiat Oncol 2014; 24 (04) 279-288
    CrossrefPubMedGoogle Scholar
  • 22 Gállego Pérez-Larraya J, Delattre JY. Management of elderly patients with gliomas. Oncologist 2014; 19 (12) 1258-1267
    CrossrefPubMedGoogle Scholar
  • 23 Tabouret E, Tassy L, Chinot O, Crétel E, Retornaz F, Rousseau F. High-grade glioma in elderly patients: can the oncogeriatrician help?. Clin Interv Aging 2013; 8: 1617-1624
    PubMedGoogle Scholar
  • 24 Zarnett OJ, Sahgal A, Gosio J. , et al. Treatment of elderly patients with glioblastoma: a systematic evidence-based analysis. JAMA Neurol 2015; 72 (05) 589-596
    CrossrefPubMedGoogle Scholar
  • 25 Franceschi E, Depenni R, Paccapelo A. , et al; PERNO Study Group. Which elderly newly diagnosed glioblastoma patients can benefit from radiotherapy and temozolomide? A PERNO prospective study. J Neurooncol 2016; 128 (01) 157-162
    CrossrefPubMedGoogle Scholar
  • 26 Mason M, Laperriere N, Wick W. , et al. Glioblastoma in the elderly: making sense of the evidence. Neurooncol Pract. 2016; 3 (02) 77-86
    PubMedGoogle Scholar
  • 27 Arvold ND, Reardon DA. Treatment options and outcomes for glioblastoma in the elderly patient. Clin Interv Aging 2014; 9: 357-367
    PubMedGoogle Scholar
  • 28 Burton E, Ugiliweneza B, Woo S, Skirboll S, Boaky M. A Surveillance, Epidemiology and End Results-Medicare data analysis of elderly patients with glioblastoma multiforme: Treatment patterns, outcomes and cost. Mol Clin Oncol 2015; 3 (05) 971-978
    PubMedGoogle Scholar
  • 29 Babu R, Komisarow JM, Agarwal VJ. , et al. Glioblastoma in the elderly: the effect of aggressive and modern therapies on survival. J Neurosurg 2016; 124 (04) 998-1007
    CrossrefPubMedGoogle Scholar