Article
Treatment of elderly patients with malignant or benign brain tumors
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Authors
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Katrin Rudolph
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
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Gabriele Schackert
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
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Dietmar Krex
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
| Published: | September 16, 2010 |
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Outline
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Objective: Elderly patients are not included in most clinical trails. Therefore, evidence-based data on how to treat those patients are scarce. However, the growing number of elderly patients brings that problem into the focus. We performed that study to investigate whether elderly (>75 years) patients with malignant (glioma) or benign (meningioma) brain tumors have more frequent and/or more serious complications and should therefore experience the same treatment modalities as younger patients.
Methods: All patients older than 75 years (75+) with primary intracranial tumors, who had been treated between 2003 and 2007 in our department, were included in that retrospective analysis. In a second population all patients younger than 50 years (50-), matching the first group in diagnosis and sex were included. Clinical data, treatment parameters, postoperative complications and outcome were recorded. Chi-square, Fisher´s exact and Kaplan-Meier statistics were used.
Results: 105 patients with five different diagnoses were included. We focus on glioblastoma (57 patients; 54%) and meningioma Grade I and II (n=20 each; 19%) patients. Surgical complications and neurological deterioration concerning motor function, sensory and cerebral nerve deficits were equally distributed between 75+ and 50-; however, 75+ had worse KPS at discharge because of decreased level of orientation and alertness resulting in temporary dependency. 75+ were treated less intensive with lower doses (44% <59 Gy) of adjuvant radiotherapy and almost no (n=4) chemotherapy regimen. Overall survival was significantly worse in 75+ for both tumor groups.
Conclusions: Elderly patients with primary intracranial malignant or benign tumors should be treated like younger adults as no more or severe surgical or neurological complications are expected. To improve overall survival an adjuvant therapy should be applied whenever possible. Postoperative decreased level of alertness is a concern that might be enfaced by special rehab programs.
