Clinical characteristics and treatment of high-grade gliomas in the elderly patients

Abstract

Objective To investigate the clinical characteristics and treatment regimens of high-grade gliomas in the elderly patients. Methods A retrospective study including 32 elderly patients with high-grade gliomas was conducted. Those patients were consecutively admitted to Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from April 2012 to August 2017 and enrolled into this study. Clinical characteristics, Karnofsky performance status (KPS), comorbidities (Charlson comorbidity index), tumor pathology classification, treatment regimen and overall patient survival were analyzed. All patients underwent tumor resection or biopsy, followed by concurrent chemoradiotherapy, chemotherapy, or targeted therapy. The Kaplan-Meier method was used to explore the effects of surgical methods, comorbidities and KPS on the overall survival of patients. Results The patients enrolled into this study included 21 males and 11 females. Their age ranged from 65 to 79 years old with an average of 71.9±6.9 years old. Among them, there were 22 (68.7%) cases with glioblastoma [World Health Organization (WHO) grade Ⅳ] and 10 (31.3%) cases with WHO grade Ⅲ gliomas. The median KPS score was 78.1 (range: 40-90). The range of assessment results based on Charlson comorbidity index was 4 to 8 with a median of 5.7. Of the 32 patients, 21 patients (65.6%) underwent resection and 11 (34.4%) underwent biopsy. Seven patients underwent standard Stupp regimen after operation, 9 patients received temozolomide adjuvant chemotherapy without radiotherapy, 1 patient received targeted therapy, and 11 patients received no further treatment. Four cases were lost to follow-up. The median survival time of 32 patients was 15.8 months(range: 1.2-73.3 months). Survival analysis showed that surgical methods, preoperative KPS, and Charlson comorbidity index were not factors influencing overall survival of patients (all P>0.05). Conclusions Elderly patients with high-grade gliomas are generally in poor health conditions and have multiple comorbidities. Despite having undergone comprehensive treatment, including surgery, radiotherapy and chemotherapy, survival of those patients still seems to be relatively short. Therefore, when deciding treatment regimen, a relatively favorable treatment plan should be selected according to the specific conditions of the patient. Key words: Glioma; Aged; Disease attributes; Treatment; High grade glioma