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."
Other organizations involved with the study are the H. Lee Moffitt Cancer Center and Research Institute, and the College of Public Health, University of South Florida, Tampa.
About University Hospitals
With 150 locations throughout Northeast Ohio, University Hospitals serves the needs of patients through an integrated network of hospitals, outpatient centers and primary care physicians. At the core of our Health System is University Hospitals Case Medical Center. The primary affiliate of Case Western Reserve University School of Medicine, University Hospitals Case Medical Center is home to some of the most prestigious clinical and research centers of excellence in the nation and the world, including cancer, pediatrics, women's health, orthopedics and spine, radiology and radiation oncology, neurosurgery and neuroscience, cardiology and cardiovascular surgery, organ transplantation and human genetics. Its main campus includes the internationally celebrated Rainbow Babies & Children's Hospital, ranked best in the Midwest and first in the nation for the care of critically ill newborns; MacDonald Women's Hospital, Ohio's only hospital for women; and Ireland Cancer Center, which holds the nation's highest designation by the National Cancer Institute of Comprehensive Cancer Center. For more information, go to www.uhhospitals.org
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