Risks and Benefits of Glioblastoma Resection in Older Adults: A Retrospective Austrian Multicenter Study

Autor: Andreas Gruber, Julian Rechberger, Behnam Rezai Jahromi, Niklas Thon, Alexander Romagna, Mark R. McCoy, Christoph Schwartz, Philipp Geiger, Sophie Winkler, Trenkler Johannes, Lukas Weiss, Barbara Ladisich, Georg Zimmermann, Gerd Fastner, Eugen Trinka, Mika Niemelä, Juergen Steinbacher, Peter A Winkler, Serge Weis, Sabine Spiegl-Kreinecker, Harald Stefanits
Přispěvatelé: HUS Neurocenter, Neurokirurgian yksikkö, University of Helsinki, Department of Neurosciences
Rok vydání: 2020
Předmět:
Male
medicine.medical_treatment
Neurosurgical Procedures
3124 Neurology and psychiatry
Treatment-associated morbidity
Elderly
0302 clinical medicine
Risk Factors
Modified Rankin Scale
ELDERLY-PATIENTS
Outcome
Aged
80 and over
Brain Neoplasms
TEMOZOLOMIDE
Prognosis
MALIGNANT GLIOMA
3. Good health
Treatment Outcome
Austria
030220 oncology & carcinogenesis
Biomarker (medicine)
Population study
Female
NEWLY-DIAGNOSED GLIOBLASTOMA
RADIOTHERAPY
medicine.drug
medicine.medical_specialty
Glioblastoma multiforme
MULTIFORME
03 medical and health sciences
RADIATION-THERAPY
Internal medicine
SURVIVAL OUTCOMES
medicine
Humans
Aged
Retrospective Studies
EUROPEAN ASSOCIATION
Chemotherapy
Temozolomide
Performance status
business.industry
3112 Neurosciences
Biomarker
Adjuvant treatment
Resection
3126 Surgery
anesthesiology
intensive care
radiology
Confidence interval
Radiation therapy
Surgery
Neurology (clinical)
Glioblastoma
business
RESPONSE ASSESSMENT
030217 neurology & neurosurgery
Zdroj: World Neurosurgery. 133:e583-e591
ISSN: 1878-8750
DOI: 10.1016/j.wneu.2019.09.097
Popis: Objective To assess the prognostic profile, clinical outcome, treatment-associated morbidity, and treatment burden of elderly patients with glioblastoma (GBM) undergoing microsurgical tumor resection as part of contemporary treatment algorithms. Methods We retrospectively identified patients with GBM ≥65 years of age who were treated by resection at 2 neuro-oncology centers. Survival was assessed by Kaplan-Meier analyses; log-rank tests identified prognostic factors. Results The study population included 160 patients (mean age, 73.1 ± 5.1 years), and the median contrast-enhancing tumor volume was 31.0 cm3. Biomarker analyses revealed O(6)-methylguanine-DNA methyltransferase–promoter methylation in 62.7% and wild-type isocitrate dehydrogenase in 97.5% of tumors. The median extent of resection (EOR) was 92.3%, surgical complications were noted in 10.0% of patients, and the median postoperative hospitalization period was 8 days. Most patients (60.0%) received adjuvant radio-/chemotherapy. The overall treatment-associated morbidity was 30.6%. The median progression-free and overall survival were 5.4 months (95% confidence interval [CI], 4.6–6.4 months) and 10.0 months (95% CI, 7.9–11.7 months). The strongest predictors for favorable outcome were patient age ≤73.0 years (P = 0.0083), preoperative Karnofsky Performance Status Scale score ≥80% (P = 0.0179), postoperative modified Rankin Scale score ≤1 (P Conclusions Clinical outcome for elderly patients with GBM remains limited. Nonetheless, the observed treatment-associated morbidity and treatment burden were moderate in the patients, and patient age and performance status remained the strongest predictors for survival. The risks and benefits of tumor resection in the age of biomarker-adjusted treatment concepts require further prospective evaluation.
Databáze: OpenAIRE
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