Adjuvant Therapy for Old Age Glioblastoma Patients

Abstract

Objective: Since the advent of Temozolomide (TMZ), optimum management for elderly patients with newly 
diagnosed Glioblastoma (GBM) is still elusive. The object of this study was to clarify outcomes of present 
management. 
Study Design: Long term prospective study 
Place and Duration of Study: This study was carried out on patients who were treated at the Aseer Central 
Hospital Abha KSA, Frontier Medical College Abbottabad, Women Medical College Abbottabad and those operated 
privately between August 2001 and August 2013.
Material and Methods: This is a long term study of 41 consecutive cases involving patients aged 55 years or more 
with newly diagnosed GBM. The patients' median age was 61 years (range 55-87 years). Twenty nine patients 
underwent resection and rest underwent biopsy. Patients with deep-seated lesions and multifocal lesions (12 
patients= 29.26%) were preferably biopsied than gross total resection. Eighteen patients (43.90%) were treated with 
chemotherapy (mostly TMZ) with radiation therapy (RT) and Six (14.63%) with RT alone. Three patients (7.31%) 
received only palliative care after surgery. 
Results: New neurological deficits developed in 5 patients (12.19%). Postoperative hemorrhage occurred in 8 
patients (19.51%), all of whom underwent biopsy. Chemotherapy complications occurred in 19.51% (Advanced 
hematological complications in 14.63%). 
The overall median values for progression-free survival and overall survival were 4.5 and 6 months respectively. 
Younger age, single lesion resection and adjuvant treatment were associated with better overall survival. Only 
adjuvant treatment was significantly associated with prolonged progression-free survival. With combined therapy 
containing resection, RT, and chemotherapy, the median progression-free survival and overall survival were 7.5 and 
11 months, respectively. 
Conclusions: The prognosis for GBM worsens with increasing age in elderly patients. When high risk factors are 
present, resection with adjuvant treatment are associated with prolonged survival but are with associated risks. 
Advanced age alone should not preclude optimal resection followed by adjuvant radio-chemotherapy.