Treatment of malignant gliomas in the elderly

The benefit of standard treatment of malignant glioma in older patients is debated. In order to assess the effect of a combination of surgery, radioth erapy and chemotherapy on survival of elderly patients with high grade glio mas, 30 consecutive patients older than 70 years with malignant supratentor ial gliomas were studied between 9/93 and 9/96. Median age was 73 years (70 -79). The mean Karnofsky performance status (KPS) was 66 (30-100). Patients underwent maximum possible surgery, followed by a course of radiotherapy ( 45 Gy/25 fractions/5 weeks) with 3 or 4 orthogonal beams and a 2 cm margin around the tumor bed. The administration of chemotherapy was left at the di scretion of the responsible physician and 12 patients received reduced dose nitrosourea-based chemotherapy. The overall median survival was 36 weeks. The median time to progression was 26 weeks. Three months after surgery, 26 patients were alive, 5 were in complete response, 2 in partial response an d 10 were stabilized. Pre-radiotherapy KPS was the only significant prognos tic factor with a median survival of 40 weeks in patients with KPS greater than or equal to 70 and 25 weeks when KPS was > 70 (logrank test, p = 0.05) . In responding and stable patients (57% of the group) the median KPS was 6 8 and 66 at 1 and 3 months after the completion of radiotherapy. There was no case of radiotherapy-induced dementia with this regimen. Four out of 12 patients who received chemotherapy, experienced WHO grade 3/4 hematotoxicit y. This study suggest that some patients older than 70 years with KPS greater than or equal to 70 may benefit from the treatment of malignant gliomas wit h surgery followed by reduced dose of limited field radiotherapy. Further s tudies are needed to define the most appropriate dose of radiotherapy and t o evaluate further the risk/benefit ratio of a reduced dose chemotherapy in this population.