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Study: Patients 75 years and older with brain tumors may benefit from more aggressive treatment
May 20, 2008Aggressive multi-modality treatments may lead to better outcomes
A new study from University Hospitals Case Medical Center (UHCMC) finds that elderly patients - 75 years old and older-- with malignant brain tumors are not treated as aggressively as patients between 65 and 75 years old. Furthermore, the researchers find that if patients over 75 years old are treated aggressively, such as with surgery and radiation, they have better survival rates. The findings appear in the April issue of the Journal of Neurosurgery.
Using the Surveillance, Epidemiology and End Results (SEER) Medicare-linked database, the researchers led by Jill S. Barnholtz-Sloan, Ph.D., of the Comprehensive Cancer Center at Case Western Reserve University and University Hospitals, looked at the records of 1753 patients who were treated for glioblastoma multiforme (GBM) and of 205 patients treated for anaplastic astrocytoma (AA) between 1991 and 1999. GBMs are the most common malignant brain tumors in adults. AAs are less common, but are treated similarly to GBMs. Both have a poor prognosis, and as the American population ages, the incidence of these brain tumors is on the rise.
The researchers looked at whether patients received a biopsy only, surgery only, biopsy and radiation, surgery and radiation, or surgery, radiation and chemotherapy.
"The odds of undergoing aggressive treatment - surgery followed by radiation with or without chemotherapy, which is the "standard of care" in the United States in younger individuals - decreased significantly in individuals who were 75 years old or older," said Dr. Barnholtz-Sloan.
"These findings suggest that older patients with brain tumors do not receive the more aggressive, effective therapies and hence have worse survival," she said.
Andrew Sloan, M.D., senior author and a neurological cancer surgeon in the Neurological Institute and Ireland Cancer Center at UHCMC, said, "Although there has been a reluctance to aggressively treat elderly patients, this study suggests that neurosurgeons and neuro-oncologists may need to re-examine their approach to these patients."
In an accompanying editorial, E. Antonio Chiocca, M.D., Ph.D., of the James Comprehensive Cancer Center at The Ohio State University Medical Center, writes, "The findings-seem to confirm findings from other retrospective and prospective analyses suggesting that treatment of elderly patients with GBM employing multimodal therapies does lead to superior outcomes without affecting their mental abilities or producing unbearable side effects."
University Hospitals of Cleveland
The researchers looked at whether patients received a biopsy only, surgery only, biopsy and radiation, surgery and radiation, or surgery, radiation and chemotherapy.
"The odds of undergoing aggressive treatment - surgery followed by radiation with or without chemotherapy, which is the "standard of care" in the United States in younger individuals - decreased significantly in individuals who were 75 years old or older," said Dr. Barnholtz-Sloan.
"These findings suggest that older patients with brain tumors do not receive the more aggressive, effective therapies and hence have worse survival," she said.
Andrew Sloan, M.D., senior author and a neurological cancer surgeon in the Neurological Institute and Ireland Cancer Center at UHCMC, said, "Although there has been a reluctance to aggressively treat elderly patients, this study suggests that neurosurgeons and neuro-oncologists may need to re-examine their approach to these patients."
In an accompanying editorial, E. Antonio Chiocca, M.D., Ph.D., of the James Comprehensive Cancer Center at The Ohio State University Medical Center, writes, "The findings-seem to confirm findings from other retrospective and prospective analyses suggesting that treatment of elderly patients with GBM employing multimodal therapies does lead to superior outcomes without affecting their mental abilities or producing unbearable side effects."
University Hospitals of Cleveland
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Paradigm shift: Switch for programmed cell death promotes spread of glioblastoma
Malignant tumors have usually lost their ability to destroy themselves by programmed cell death, or apoptosis. Therefore, tumors are often resistant to chemotherapy or radiation therapy, whose effect is based on forcing tumor cells to commit suicide.
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