Large Effect of Age on the Survival of Patients with Glioblastoma Treated with Radiotherapy and Brachytherapy Boost

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Abstract
A RETROSPECTIVE REVIEW was undertaken to study the influence of age on the survival of patients undergoing brachytherapy boost for glioblastoma multiforme. From February 1981 through December 1992, 159 adults with primary glioblastoma multiforme underwent high-activity iodine-125 brain implant boost after external beam radiotherapy. There were 98 men and 61 women, ranging in age from 18 to 73 years (median, 52 yr). Karnofsky performance scores ranged from 70 to 100 (median, 90). Surgery before radiotherapy consisted of biopsy in 7% of patients, subtotal resection in 66%, and gross total resection in 27%. External beam radiotherapy doses ranged from 39.6 to 76.8 Gy, with 91% of patients receiving 59.4 to 61.2 Gy. Brachytherapy doses ranged from 35.7 to 66.5 Gy (median, 55.0 Gy) at 0.30 to 0.70 Gy per hour (median, 0.43 Gy/h). Reoperations were performed in 81 patients (51%). Information on quality of life was available for 13 of the 14 living 3-year survivors; 10 patients were steroid independent, and mean Karnofsky performance scores had decreased from 92 at the time of brachytherapy to 75 at the last follow-up. Univariate and multivariate analyses showed that age was the most important parameter influencing survival (P< 0.0005). The nine patients 18 to 29.9 years old had a 3-year survival probability of 78 ± 14% (median survival was not yet reached at the time of this report), with a follow-up of 145 to 511 weeks in living patients (median, 322 wk). The 19 patients who were 30 to 39.9 years old had a median survival of 109 weeks, compared with that of 96 weeks for the 45 patients who were 40 to 49.9 years old, 77 weeks for the 46 patients who were 50 to 59.9 years old, and 76 weeks for the 40 patients who were ≥60 years old. Age is a well-known prognostic indicator, which should be considered when designing and analyzing clinical trials. This large experience permitted an analysis of survival by patient decade, graphically illustrating this point and showing a surprisingly good survival probability for patients 18 to 29.9 years old.