Is surgical resection useful in elderly newly diagnosed glioblastoma patients? Outcome evaluation and prognostic factors assessment

• Published in: Acta neurochirurgica 2018-09, Vol.160 (9), p.1779-1787
• Main Authors: Pessina, Federico, Navarria, Pierina, Cozzi, Luca, Rudà, Roberta, Nibali, Marco Conti, Simonelli, Matteo, Costa, Francesco, Santoro, Armando, Clerici, Elena, Carta, Giulio, Scorsetti, Marta, Bello, Lorenzo
• Format: Article
• Language: English
• Subjects: Biopsy; Brain cancer; Brain tumors; Chemotherapy; Evaluation; Geriatrics; Glioblastoma; Interventional Radiology; Medical prognosis; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Older people; Original Article - Brain Tumors; Radiation; Radiation therapy; Surgery; Surgical Orthopedics; Survival; Temozolomide
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-018-3599-4

ASTRACT Background The incidence of glioblastoma among elderly patients is constantly increasing. The value of radiation therapy and concurrent/adjuvant chemotherapy has been widely assessed. So far, the role of surgery has not been thoroughly investigated. The study aimed to evaluate safety and impact of several entities of surgical resection on outcome of elderly patients with newly diagnosed glioblastoma treated by a multimodal approach. Methods Patients ≥ 65 years, underwent surgery were included. The extent of surgical resection (EOR) was defined as complete resection (CR = 100%), gross total resection (GTR = 90–99%), sub-total resection (STR = 78–90%), partial resection (PR = 30–78%), and biopsy. After surgery, all patients received adjuvant radiotherapy (60/2 Gy fraction) with concomitant/adjuvant temozolomide chemotherapy. Results From March 2004 to December 2015, 178 elderly with a median age of 71 years (range 65–83 years) were treated. CR was obtained in 8 (4.5%), GTR in 63 (35.4%), STR in 46 (25.8%), PR in 16 (9.0%), and biopsy in 45 (25.3%). RT was started in all patients, concurrent/adjuvant CHT in 149 (83.7%) and 132 (74.2%). The median follow-up time was 12.2 months (range 0.4–50.4 months). The median, 1- and 2-year progression-free survival was 8.9 months (95%CI 7.8–100 months), 32.0 ± 3.5%, and 12.9 ± 2.6%. The median, 1- and 2-year overall survival were 12.2 (95%CI 11.3–13.1 months), 51.1 ± 3.7%, and 16.3 ± 2.9%. Tumor location, extent of resection, and neurological status after surgery statistically affected survival ( p  ≪ 0.01). Conclusion Maximal surgical resection is safe and feasible in elderly patients with influence on survival. A preoperative evaluation has to be carried out.