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  3. 20. Adjuvant Therapy for Old Age Glioblastoma Patients
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20. Adjuvant Therapy for Old Age Glioblastoma Patients

Salman A. Jaffery

Assoc. Prof. of Neurosurgery, Women Medical College, Abbottabad.


Objective: Since the advent of Temozolomide (TMZ), optimum management for elderly patients with newly diagnosed Glioblastoma (GBM) is still elusive. The object of this study was to clarify outcomes of present management.

Study Design: Long term prospective study

Place and Duration of Study:  This study was carried out on patients who were treated at the Aseer Central Hospital Abha KSA, Frontier Medical College Abbottabad, Women Medical College Abbottabad and those operated privately between August 2001 and August 2013.

Material and Methods: This is a long term study of 41 consecutive cases involving patients aged 55 years or more with newly diagnosed GBM. The patients' median age was 61 years (range 55-87 years). Twenty nine patients underwent resection and rest underwent biopsy. Patients with deep-seated lesions and multifocal lesions (12 patients= 29.26%) were preferably biopsied than gross total resection. Eighteen patients (43.90%) were treated with chemotherapy (mostly TMZ) with radiation therapy (RT) and Six (14.63%) with RT alone. Three patients (7.31%) received only palliative care after surgery.

Results: New neurological deficits developed in 5 patients (12.19%). Postoperative hemorrhage occurred in 8 patients (19.51%), all of whom underwent biopsy. Chemotherapy complications occurred in 19.51% (Advanced hematological complications in 14.63%).

The overall median values for progression-free survival and overall survival were 4.5 and 6 months respectively. Younger age, single lesion resection and adjuvant treatment were associated with better overall survival. Only adjuvant treatment was significantly associated with prolonged progression-free survival. With combined therapy containing resection, RT, and chemotherapy, the median progression-free survival and overall survival were 7.5 and 11 months, respectively.

Conclusions: The prognosis for GBM worsens with increasing age in elderly patients. When high risk factors are present, resection with adjuvant treatment are associated with prolonged survival but are with associated risks.

Advanced age alone should not preclude optimal resection followed by adjuvant radio-chemotherapy.

Key Words: Glioblastoma, Old Patients, Adjuvant Therapy, Overall Survival, Progression Free Survival.