Malignant supratentorial glioma in the elderly: is radiotherapy useful?

Abstract

Objectives: To determine (1) if radiotherapy (RT) improves survival or neurologic function in elderly patients with malignant supratentorial glioma (MSG) and (2) which prognostic factors predict survival.

Background: The prevalence of MSG is increasing because both the number of elderly patients and the age-adjusted incidence are increasing. Because age is a powerful negative prognostic factor in MSG, it is not clear if RT is useful in the elderly.

Design/methods: We retrospectively studied 103 patients from the Southern Alberta Cancer Registry diagnosed January 1, 1978, to December 31, 1993, aged 70 yrs, with MSG in whom sufficient clinical and follow-up information was available. Multiple treatment and patient factors were compared with survival and neurologic function score. Diagnosis was confirmed in 15 (14.6%) by biopsy, in 66 (64.1%) by resection, and in 22 (21.4%) by clinical course and typical radiographic appearance only.

Results: All patients died and median survival was 3.9 months. Better neurologic function at diagnosis and administration of RT were independently associated with significantly longer survivals (p = 0.001 and < 0.001; log rank test). However, RT was only associated with longer survival in patients aged less than 80 years. Neurologic status only rarely improved following RT.

Conclusions: The prognosis for elderly patients with MSG is poor. RT is unlikely to benefit patients who are aged 80 years or older. RT has a short-lived benefit for patients who are functionally disabled.