Elderly patients affected by glioblastoma treated with radiotherapy: the role of serum hemoglobin level

OBJECTIVE: To investigate the role of serum hemoglobin level for elderly patients with glioblastoma treated with radiotherapy (RT). METHODS: Patients older than 65 years with glioblastoma, who underwent surgical resection/biopsy and RT, were evaluated. Total doses were 30 or 60 Gy:30 Gy in 10 or 5 fractions (palliative approach) and 60 Gy in 30 fractions (standard approach). In the standard approach, temozolomide was administered concomitantly and adjuvantly to RT. Before starting and weekly during RT, serum hemoglobin level was assessed for all patients. Recursive partitioning analysis (RPA) was used to classify patients. RESULTS: From 2005 to 2011, 45 patients (median age 71 years) were treated in our institution. Hemoglobin level less than 12 was confirmed in 11 patients. Median progression-free survival (PFS) and overall survival (OS) were 8 and 13 months, respectively. Only RPA class and extent of surgery correlated to PFS (p = .002, p = .04, respectively). RPA class, surgery, and RT dose affected OS (p = .003, p = .02, p = .03, respectively), whereas age (<70 vs. ≥70 years) and hemoglobin level (<12 vs. ≥12) did not influenced outcome (p = 0.2, p = 0.5, respectively). CONCLUSION: Our data suggested that extent of surgery and RPA class remain independent prognostic factor, whereas patients' anemia did not adversely affect prognosis in glioblastoma elderly patients.