Low-grade gliomas in older patients

Long-term follow-up from Mayo Clinic

Authors


  • Presented at the 13th Annual Scientific Meeting of the Society for Neuro-Oncology, Lake Las Vegas, Nevada, November 20-23, 2008.

  • We thank the biostatisticians at the Mayo Clinic Center for translational science activities.

Abstract

BACKGROUND:

Low-grade gliomas (LGGs) are uncommon in older patients, and long-term clinical behavior and prognostic factors are not well defined in this group.

METHODS:

The authors retrospectively searched their tumor registry for the records of adult patients (≥18 years) diagnosed as having nonpilocytic LGG between 1960 and 1992 at Mayo Clinic. The Kaplan-Meier method was used to estimate progression-free survival and overall survival (OS) in patients aged 55 years and older.

RESULTS:

Of 314 patients initially identified, 32 were aged at least 55 years, with a median age at diagnosis of 61 years (range, 55-74 years). Median follow-up was 17.3 years for survivors. Operative pathologic diagnoses comprised astrocytoma (n = 22, 69%), mixed oligoastrocytoma (n = 7, 22%), and oligodendroglioma (n = 3, 9%). Gross total resection was achieved in 1 patient, radical subtotal resection in 1, and subtotal resection in 14; 16 patients had biopsy only. Postoperative radiotherapy or chemotherapy was given to 23 (72%) patients and 1 (3%) patient, respectively. Median OS was 2.7 years for all patients: 3 years with resection and 2.2 years with biopsy only (P = .58). The 5- and 10-year OS rates were 31% and 18%, respectively. Factors adversely affecting OS on univariate analysis were enhancement on computed tomography (P < .001) and supratentorial location (P = .03).

CONCLUSIONS:

This retrospective series of older patients suggests that intracranial LGG in this age group behaves aggressively. Pathologic sampling error failing to recognize higher-grade tumors does not seem to account for these poor outcomes. Aggressive management with maximally safe resection followed by adjuvant therapy should be strongly considered. Cancer 2009. © 2009 American Cancer Society.

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