Efficacy of radiotherapy for malignant gliomas in elderly patients

Purpose: Age above 65 years is a strong negative prognostic factor for surv ival in patients with malignant gliomas (MG) treated with radiotherapy (RT) and its value has been questioned. We analyzed the effect of RT on the sur vival of elderly patients with malignant gliomas, Methods and Materials: We examined 85 consecutive elderly patients with a h istological diagnosis of MG. Age ranged from 65 to 81 years (median 70 year s). Glioblastoma multiforme (GBM) was diagnosed in 64 patients (75.3%), Sur gical treatment included needle biopsy in 32 patients (37.6%), Median posto perative Karnofsky Performance Status (KPS) was 60 (range: 30-100), Surviva l probability was estimated using Kaplan-Meier method and compared with the log-rank test. Crude and adjusted hazard ratios (HR) were calculated using Cox's regression models. Results: Median survival time for all patients was 18.1 weeks. In multivari ate analysis, RT was the only kindependent prognostic variable for survival (HR: 9.1 [95% CI: 4.5-18.7]). Forty-two patients did not start RT mostly d ue to low KPS (<50), The median survival of the 43 patients who started RT was 45 weeks. In these patients, Cox multivariate analysis indicated that a ge was independently associated with prolonged survival (HR: 2.85 [95% CI 1 .31-6.19]). Median survival of patients age 70 years and younger was 55 wee ks compared with 34 weeks for patients older than 70 years. Conclusions: The overall survival for elderly patients with MG is poor. RT seems to improve survival in patients up to 70 years, but in older patients treated with RT the survival is significantly shorter. (C) 1998 Elsevier S cience Inc.