AGE INFLUENCES CHEMOTHERAPY RESPONSE IN ASTROCYTOMAS

Objective: In patients with cerebral astrocytomas treated with nitroso urea-based chemotherapy, to determine whether age is predictive of res ponse, time to progression, survival, or rate of complications. Design : Retrospective analysis of neuroimaging studies and clinical data. Se tting: University hospital with a busy neuro-oncology service. Patient s: One hundred forty-eight patients with pathologically confirmed mali gnant astrocytomas or recurrent astrocytomas. Results: Partial respons e occurred in 39% of patients aged <40 years, in 17% of those aged 40 to 59, and in only 5% of those aged greater than or equal to 60 (p < 0 .001). Median time to progression after chemotherapy was 23 weeks in p atients aged <60 and 6 weeks in patients aged greater than or equal to 60 (p < 0.001). Median survival after chemotherapy was 43 weeks in pa tients aged <60 but only 24 weeks in patients aged greater than or equ al to 60 (p < 0.001). Differences between age groups in response rate, time to progression, and survival persisted with adjustment for tumor grade. The risk of myelosuppressive complications requiring hospitali zation was significantly related to age (p = 0.03); such complications occurred in 35% of patients aged greater than or equal to 60 and 16% of patients under 60 years. Conclusion: Age is strongly predictive of the likelihood of a response to chemotherapy, time to progression, sur vival, and risk of myelosuppressive complications. Patients aged great er than or equal to 60 have a lower chance of benefit and an increased risk of myelosuppressive complications from chemotherapy for astrocyt omas compared with younger patients.