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  • Effectiveness of Radiotherapy for Elderly Patients with Grade III Anaplastic Astrocytoma

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    Chirag G. Patil MD MS; Kristen Nosova M.B.A.; Debraj Mukherjee MD, MPH; Maxwell Boakye MD; Amin Mirhadi; Shivanand P. Lad MD PhD; Behrooz Hakimian MD; Keith L. Black MD; Miriam Nuno PhD

    Study Design:

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    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Radiation is utilized routinely in the management of anaplastic astrocytoma (AA). However, the role of radiation therapy (RT) in the optimal management of elderly patients with Grade III, AA remains controversial. We used the SEER cancer registry to evaluate the effectiveness of RT in elderly AA patients.

    Methods: Surveillance, Epidemiology, and End Results (SEER) registry was used to query a total of 489 patients over 70 years of age diagnosed with histology confirmed Grade III, AA between 1973-2005. Overall survival was evaluated using the Kaplan-Meier method. Multivariate analysis was performed.

    Results: Among the 489 elderly patients with AA, 62% received radiation and 60% underwent surgical resection as part of their initial treatment. 38% of patients underwent surgery plus RT, 24% had RT only, 23% had surgery only and 15% had no treatment. Median survival for patients who underwent RT plus surgery was 6 months while patients who did not receive surgery or RT survived only 2 months. In comparison, the surgery only cohort had survival of 3 months and the RT only group had median survival of 4 months. Patients who received RT as part of their initial treatment had significantly longer survival than patients who did not receive RT (5 months vs. 3 months p<0.0001). Multivariate analysis showed that radiotherapy significantly improved overall survival (hazard ratio [HR 0.63], 95% confidence interval [CI: 0.52-0.76), p<.0001) after adjusting for extent of resection, age, and year of diagnosis. Patients over 70 years of age were less likely to receive RT than younger patients (62% vs. 80%, p<0.001).

    Conclusions: Elderly patients with Anaplastic Astrocytoma who underwent RT as part of their initial treatment had better overall survival compared to patients who did not receive RT.

    Patient Care: This research rigorously shows that elderly patients with anaplastic astrocytoma benefit from radiation therapy and supports the use of radiation therapy in patients over 70 years of age.

    Learning Objectives: By the conclusion of this session participants should be able to: 1. Discuss the survival outcomes of elderly anaplastic astrocytoma patients. 2.Describe the effect of radiotherapy on outcomes of patients with anaplastic astrocytoma. 3. Describe the utilization of radiotherapy in the elderly AA patients as compared to younger AA patients.


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