gms | German Medical Science

Elderly patients (≥65 years) with the diagnosis of malignant brain tumour, tend to have a lower Karnofsky-Index and a shorter survival time than younger patients. It is of particular importance to consider both if patients of this age are able to tolerate the side-effects and if they benefit from treatment.

We retrospectively analysed 224 patients (≥65 years) who underwent stereotactic biopsy (2001-2003). Histologically in all patients malignant brain tumors were diagnosed. 13 patients with metastases received LINAC radiosurgery without biopsy. Beside age and Karnofsky performance status, diagnosis, treatment, survival time after diagnosis and duration of hospitalisation were examined. Complications in the consecutive post-operative period were analysed (CCT, neuronal symptoms).

The patients age range from 65 to 87 years (median 71 years). 30% of the patients (n=76) suffered from glioblastoma multiforme and 32 of them received radiation therapy (42%). Patients with anaplastic astrocytoma n=49 (20%) were treated in 59% (n=29), patients with astrocytoma WHO II n=12 (5%) in 67% (n=8) with radio-therapy. 21 patients with a glioblastoma multiforme (28%) and 8 patients with an anaplastic astrocytoma (16%) were treated with supportive therapy. Patients with metastasis n=67 (27%) underwent manifold therapies: 33% (n=22) received interstitial radio-surgery, 45% (n=30) LINAC radio-surgery, 31% (n=21) radio-therapy, 5% (n=3) chemotherapy, 5% resection and 5% supportive therapy because of a low performance status. Patients with intracranial lymphoma n=24 (10%) were usually treated with chemotherapy. The mean hospital stay was 7 days. Complications after biopsy were seen in 6 of 224 biopsies (3%). The median survival time after biopsy could be obtained in 115 cases. Patients with metastasis (n=46) survived 143, with a glioblastoma (n=42) 119 and with an anaplastic astrocytomas (n=21) 127 days after biopsy.

Because of minor surgical trauma, short hospitalisation and low complication rate, stereotactic biopsy is a useful method also for patients with a lower performance status. The decision for therapy depended more on the co-morbidity than on the age of the patients.