Malignant supratentorial glioma in the elderly: is radiotherapy useful?

To determine (1) if radiotherapy (RT) improves survival or neurologic function in elderly patients with malignant supratentorial glioma (MSG) and (2) which prognostic factors predict survival.

The prevalence of MSG is increasing because both the number of elderly patients and the age-adjusted incidence are increasing. Because age is a powerful negative prognostic factor in MSG, it is not clear if RT is useful in the elderly.

We retrospectively studied 103 patients from the Southern Alberta Cancer Registry diagnosed January 1, 1978, to December 31, 1993, aged 70 yrs, with MSG in whom sufficient clinical and follow-up information was available. Multiple treatment and patient factors were compared with survival and neurologic function score. Diagnosis was confirmed in 15 (14.6%) by biopsy, in 66 (64.1%) by resection, and in 22 (21.4%) by clinical course and typical radiographic appearance only.

All patients died and median survival was 3.9 months. Better neurologic function at diagnosis and administration of RT were independently associated with significantly longer survivals (p = 0.001 and < 0.001; log rank test). However, RT was only associated with longer survival in patients aged less than 80 years. Neurologic status only rarely improved following RT.

The prognosis for elderly patients with MSG is poor. RT is unlikely to benefit patients who are aged 80 years or older. RT has a short-lived benefit for patients who are functionally disabled.