Low‐grade gliomas in older patients

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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.