Brain Tumors and the Geriatric Patient

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Abstract
The prognosis, site of occurrence, and histologic type of primary brain tumors are age-dependent phenomena. In general, the incidence of meningiomas, acoustic Schwannomas, and glioblastomas increases with advancing age until the end of the eighth decade. Of 99 patients consecutively admitted to an aggressive multimodality treatment program for glioblastoma multiforme, 18 per cent were in the 61–70 age group and 4 per cent in the 71–80 group; the oldest was 85. The operative mortality was only 4 per cent. In 16 patients over 65, the 6- and 12-month calculated survival probabilities were 0.65 and 0.31, respectively. The Kaplan-Meier survival curve for these patients was significantly different from that for 26 patients under the age of 40. Grade 4 astrocytomas were present in 62 per cent of patients under 40 but in 83 per cent of patients over 61. In all glioblastoma populations, age is the most significant prognostic variable. The incidence of metastic brain tumors also increases with age, and all of the usual primary sites are represented. The prognosis for elderly patients with metastatic brain tumor is uniformly worse than that for younger patients, even though modern diagnostic and operative techniques carry virtually the same morbidity and mortality rates in older patients as in younger ones. It is vitally important, therefore, that the clinical effects of treatable intracranial tumors in the elderly are not ascribed to dementia, the aging process, the systemic effects of cancer, or the side effects of cancer therapy, without suitable diagnostic investigation.