Tumori, 92: 407-411, 2006 PRIMARY GLIOBLASTOMA MULTIFORME IN YOUNGER PATIENTS: A SINGLE-INSTITUTION EXPERIENCE Cuneyt ulutln', Merdan Fayda\ Gorkem Aksu', Oguz Cetinayak\ Okan Kuzhan", Fatih Ors", and Murat Beyzadeoglu 1 'Department of Radiation Oncology, 2Division of Medical Oncology, 'Department of Radiology, GATA Hospital, Ankara, Turkey Aims and background: To report our experience of patients with primary glioblastoma multiforme of young age by evaluating the characteristics, prognostic factors, and treatment out- comes. Patients and methods: Seventy patients with primary glioblas- toma multiforme ,<GBM) treated at our department between 1996 and 2004 were studied. The male-female ratio was 2.6:1. The median age was 53 (16-74). Sixty-eight patients (97"10) were operated on before radiotherapy and 2 patients (3"10) un- derwent only stereotactic biopsy. All patients received radio- therapy. Postoperative chemotherapy as an adjuvant to radio- therapy was given to 9 patients (12"10). The patients were divid- ed into 2 groups according to their age (group A 5 years, n =21 vs group B >35 years, n =49). Survival was determined with the Kaplan-Meier method and differences were compared using the log-rank test. Cox regression analysis was per- formed to identify the independent prognostic factors. Karnof- sky performance status ( 70 vs <70), age (5 vs >35 years), gender, tumor size ( vs >4 em), number of involved brain lobes (1 vs more than 1), type of surgery (total vs subtotal), preoperative seizure history (present vs absent), radiotherapy Key words: brain tumor, prognosis, radiotherapy. Introduction Glioblastoma multiforme (GBM) is one of the most common primary brain tumors in adults and carries a dismal prognosis. Despite the improvement of mi- croneurosurgical techniques, molecularly targeted thera- pies and new systemic agents combined with radiother- apy, improvements of survival have been minimal and the median survival for GBM patients is about 9-12 months. Most patients die due to disease progression within 2 years and cure was only reported in a few cas- es'", Primary (de novo) GBM constitutes about 80% of all glioblastomas. Primary GBM is characterized by a short patient history of usually less than 3 months and absence of pre-existing less malignant astrocytoma as described by Scherer? The incidence of GBM increases with age, especially after the third decade. GBM generally occurs in the sixth or seventh decade of life. Between the ages of 75 and M the incidence reaches 20 cases per 100,000 pop- ulation. Younger patients constitute a relatively small percentage of the reported GBM series":". For this rea- son, we evaluated the outcomes of GBM patients by comparing the treatment results of younger and older field (total cranium vs partial), total radiotherapy dose (60 vs 66 Gy), and adjuvant chemotherapy (present vs absent) were evaluated in univariate analysis. Results: The median survival was 10.3 months in the whole group, 19.5 months in the younger age group and 5.7 months in the older age group. During follow-up re-craniotomy was performed in 2 patients (3"10), and 1 patient (1"10) developed spinal seeding metastases and was given spinal radiotherapy. In univariate analysis younger age vs older age: median 19.5 months vs 5.27 months (P = 0.0012); Karnofsky performance status 70 vs <70: median 15.3 months vs 2.67 months (P <0.0001), and external radiotherapy dose 60 Gy vs 66 Gy: me- dian 11.6 months vs 3 months (P = 0.02) were found as signifi- cant prognostic factors for survival. In regression analysis a worse performance status (KPS <70) was found to be the only independent factor for survival (P = 0.014, 95"10 CI HR = 0.0043 [0.0001-0.15]). Conclusions: Younger patients with primary glioblastoma multi- forme had a relatively long survival (median, 19.5 months, with a 2-year survival rate of 30"10) compared to older patients. This was due particularly to their better performance status. patients. Although the number of patients included in this study is limited, we would like to present our expe- rience with younger patients. Patients and methods Patients Seventy patients with primary glioblastoma multi- forme (GBM) were treated at our institution between 1996 and 2004. Twenty-one (30%) were 35 years or younger. The male-female ratio was 2.6:1. Median age was 53 years (range, 16 to 74 years). A preoperative history of seizures was present in 24 patients (34%). Karnofsky performance status (KPS) was 70% or high- er in 36 patients (51%). The tumor was larger than 4 em in 36 patients (52%). Four (6%) patients had multicen- tric tumor. The preoperative waiting period was more than 1 month from the initial symptoms in 41 patients (58%). Preoperative midline shift was present in 45 pa- tients (64%). The patients were divided into 2 groups according to age (group A :::;35 years, n = 21 vs group B >35 years, n =49). The characteristics of all patients are presented in Table 1. Twenty-one of the 70 patients Correspondence to: Dr Cuneyt Ulutin, Kizilcik sok. 10/10 Amttepe, Ankara, Turkey. Tel +90-312-3044684; fax +90-312-3044150; e-mail culutin@yahoo.com Received October 10,2005; accepted April 18,2006.