Glioblastoma multiforme in the elderly: A therapeutic challenge

Introduction: Elderly patients with glioblastoma multiforme (GBM) are frequently excluded from cancer therapy trials, treated suboptimally or not treated at all. The average survival in elderly patients is 4-8 months. The goal of the present study was to evaluate the efficacy of different treatment options in terms of survival in an elderly population affected with GBM. Materials and methods: About 34 Patients with primary supratentorial GBM aged 65 or higher were included in this study. All patients underwent craniotomy and tumor mass resection. After surgery they received radiation therapy, chemotherapy and radioimmunotherapy in different combinations. Results: Overall median survival was 10.5 months with one patient still alive at 35 months. Survival was longer for patients who underwent total resection instead of partial (13 months vs 4 months, P = 0.006). If total en-bloc resection was used a further survival advantage was obtained (16months for en-bloc resection, 9months for inside-out resection, P = 0.008). Where a second surgical intervention was performed median survival was 21 months (P = 0.05). Survival according to adjuvant therapy has been 21 months (radiotherapy, chemotherapy, radioimmunotheraphy), 18 months (radiotherapy, chemotherapy) and 7 months (radiotherapy) (P = 0.0001). Conclusions: We think that single prognostic factor such as age should be not a reason for undertreatment.