Brain Tumors in the Elderly

Lowry, Jeanette K.; Snyder, Jon J.; Lowry, Philip W.

doi:10.1001/archneur.55.7.922

Cited by 105 publications

(23 citation statements)

References 29 publications

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“…30 These features have all been used as arguments for not offering older patients aggressive therapies for their disease. 3,30,31 These patients instead are offered needle biopsy for diagnosis with or without subsequent adjuvant therapy. 3,4 …”

Section: Discussionmentioning

confidence: 99%

Supratentorial Glioblastoma Multiforme: The Role of Surgical Resection Versus Biopsy Among Older Patients

et al. 2010

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Background The peak incidence of glioblastoma multiforme (GBM) occurs in those aged 65 years and older. However, studies on this patient group remain limited. The goal of this study is to evaluate the efficacy of surgery versus biopsy for older patients with these lesions. Methods 133 and 72 consecutive patients aged 65 years and older who underwent surgery and needle biopsy for intracranial primary (de novo) GBM between 1997 and 2007 were retrospectively reviewed. Among these patients, 40 who underwent surgical resection were matched with 40 who underwent needle biopsy alone for factors consistently shown to be associated with survival [age, Karnofsky Performance Scale (KPS) indexing, eloquent involvement, radiation, temozolomide]. Survival was expressed as estimated Kaplan–Meier plots, and log-rank analysis was used to compare survival curves. Results Mean ± standard deviation age was 73 ± 5 years, and median survival was 4.9 months. There were no significant differences in perioperative outcomes among patients who underwent surgical resection versus needle biopsy. Patients who underwent resection had median survival of 5.7 months as compared with 4.0 months for patients who underwent needle biopsy (P = 0.02). Likewise, for patients aged 70 years and older, median survival was 4.5 months for 26 patients who underwent surgical resection as compared with 3.0 months for 26 patients who underwent needle biopsy (P = 0.03). Conclusion This study demonstrates that older patients tolerate aggressive surgery without increased surgery-related morbidity and have prolonged survival as compared with similar patients undergoing needle biopsy. These findings may help guide treatment decisions for patients, their families, and their physicians.

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Section: Discussionmentioning

confidence: 99%

Supratentorial Glioblastoma Multiforme: The Role of Surgical Resection Versus Biopsy Among Older Patients

et al. 2010

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“…Stratifying the logistic model for patient's age, we found a trend towards a reduced prevalence of headache in older patients (even if this was not significant). Lowry and colleagues (12) reported that headache was significantly more common as the main presenting symptom of a brain tumour in younger age groups compared with older ones. According to them, this may be related in part to varying degrees of general brain atrophy, which leaves the subarachnoid space and ventricles larger, allowing for more expansion of space-occupying lesions (12).…”

Section: Discussionmentioning

confidence: 99%

Headache attributed to intracranial tumours: A prospective cohort study

et al. 2009

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Between January 2007 and March 2008, we prospectively studied all patients operated on for intracranial tumours in our Department of Neurosurgery. Preoperatively, all patients were interviewed by a neurologist to collect headache characteristics. Measurements of tumour and oedema volume were made using dedicated software for magnetic resonance imaging studies. Tumour histopathology was established by histological examination postoperatively. If headache improved postoperatively, a diagnosis of 'headache attributed to intracranial neoplasm' was made, according to the 2004 International Classification of Headache Disorders (ICHD-II). A multivariate logistic regression model was used to evaluate the association of headache with potential risk factors. We studied 206 subjects. The prevalence of tumour headache was 47.6%. Intracranial tumour headache was non-specific and in most cases could not be classified by current ICHD-II diagnostic criteria for primary headache syndromes. Its prevalence varied depending on volume, location and type of tumour, as well as on the patient's previous headache history.

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“…Researchers found increased use of CT scans on the elderly 75-84 and 85 or more years of age from 1986 to 1994 and this may reflect an effort by physicians to use more aggressive diagnostic testing for neurologic symptoms in the elderly [18,19] . This possibility is supported by the lack of association with the usual work-related factors such as DOE and TSFE in the internal cohort comparisons.…”

Section: Glioblastomamentioning

confidence: 99%

Long-Term Health Experience of Jet Engine Manufacturing Workers: III. Incidence of Malignant Central Nervous System Neoplasms

et al. 2010

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Objective: To explore a perceived unusual occurrence of glioblastoma at one jet engine manufacturing facility located in North Haven (NH), Connecticut (CT). Methods: Subjects were 212,513 workers ever employed in 1 of 8 manufacturing facilities from 1952 to 2001 and at risk from 1976 to 2004. We identified 722 cases of CNS neoplasms mainly by tracing through 19 state cancer registries. We computed standardized incidence ratios (SIRs) based on CT state and national rates and modeled internal relative risks (RRs). Results: We found overall deficits in cases for glioblastoma (275 cases, SIR = 0.77, CI = 0.68–0.87) and most other histology categories examined. NH workers had a not statistically significant overall 8% excess in glioblastoma (43 cases, SIR = 1.08, CI = 0.78–1.46). Salaried NH workers had a statistically significant twofold risk of glioblastoma compared with hourly workers (17 cases, RR = 2.04, CI = 1.15–3.57). Other subgroups of NH workers revealed elevated but not statistically significant glioblastoma risks but little evidence of an association with duration of employment or time since first employment. Conclusions: Incidence rates for glioblastoma and other malignant CNS neoplasm histologies were not elevated in the total cohort. The glioblastoma excesses observed among NH workers may reflect external occupational factors, non-occupational factors or workplace factors unique to NH unmeasured in the current study.

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Brain Tumors in the Elderly

Cited by 105 publications

References 29 publications

Supratentorial Glioblastoma Multiforme: The Role of Surgical Resection Versus Biopsy Among Older Patients

Supratentorial Glioblastoma Multiforme: The Role of Surgical Resection Versus Biopsy Among Older Patients

Headache attributed to intracranial tumours: A prospective cohort study

Long-Term Health Experience of Jet Engine Manufacturing Workers: III. Incidence of Malignant Central Nervous System Neoplasms

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