Analysis of Treatment Tolerance and Factors Associated with Overall Survival in Elderly Patients with Glioblastoma

Zhang, Chaocai; Wang, Xingchao; Hao, Shuyu; Su, Zhaoping; Zhang, Peng; Li, Yajie; Song, Guidong; Yu, Lanbing; Wang, Jiangfei; Ji, Nan; Xie, Jian; Gao, Zhixian

doi:10.1016/j.wneu.2016.07.079

Cited by 17 publications

(10 citation statements)

References 31 publications

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“…The summary results indicated a significant improvement in the survival outcomes in elderly patients who received GTR. Although most included studies reported a significant improvement in OS, four reports showed no significant therapeutic advantage of GTR vs. STR (27,36,38,40). This might be due to the small numbers of included patients, and wide 95%CIs were obtained.…”

Section: Discussionmentioning

confidence: 92%

“…A total of 76 studies were retrieved for full-text evaluation, and 57 were further excluded due to the following reasons: no appropriate control (n = 29), inclusion of younger patients (n = 20), and no sufficient data (n = 8). Therefore, 19 studies met our inclusion criteria and were selected for final meta-analysis (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42). There were no additional eligible studies from the manual search of the reference lists of these studies.…”

Section: Literature Searchmentioning

confidence: 99%

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Gross Total vs. Subtotal Resection on Survival Outcomes in Elderly Patients With High-Grade Glioma: A Systematic Review and Meta-Analysis

et al. 2020

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Background: The optimal strategy for the management of high-grade glioma in the elderly (≥60.0 years) remains controversial, especially regarding the effects of surgical extent on survival outcomes. The purpose of this study was to compare gross total resection (GTR) with subtotal resection (STR) for treatment effects in elderly patients with high-grade glioma.Methods: Three electronic databases were systematically searched, including PubMed, EmBase, and the Cochrane library, from inception to August 2018. Hazard ratios (HRs) or odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used to express summary effect estimates using the random-effects model. Nineteen retrospective observational studies involving a total of 10,815 elderly patients with high-grade glioma were included in this meta-analysis.Results: The summary results indicated that GTR was associated with a significant improvement in overall survival (OS) compared with STR (HR = 0.70, 95% CI = 0.64-0.77). In addition, elderly patients administered GTR showed lower risk of 3-month mortality (OR = 0.47, 95% CI = 0.24-0.93), 6-month mortality (OR = 0.38, 95% CI = 0.26-0.56), 9-month mortality (OR = 0.35, 95% CI = 0.25-0.49), and 1-year mortality (OR = 0.40, 95% CI = 0.29-0.56). Pooled OS data differed when stratified by publication year, country, sample size, disease status, and study quality.Conclusion: GTR seems to be more effective than STR in achieving longer survival in elderly patients with high-grade glioma.

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Section: Discussionmentioning

confidence: 92%

Section: Literature Searchmentioning

confidence: 99%

Gross Total vs. Subtotal Resection on Survival Outcomes in Elderly Patients With High-Grade Glioma: A Systematic Review and Meta-Analysis

et al. 2020

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“…Recent studies have shown that, in addition to conventional prognostic factors, the molecular profile of tumors can be used to select from these treatment alternatives. [3][4][5][6][7][8][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Microsurgery's place within this framework remains unclear. 6,[18][19][20][21][22] Even though gross total resection (GTR) has been proven to increase OS, little data are available concerning the risks and benefits of resections in older adults.…”

Section: Introductionmentioning

confidence: 99%

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

Schwartz

Romagna

Stefanits³

et al. 2020

World Neurosurgery

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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 AE 5.1 years), and the median contrastenhancing tumor volume was 31.0 cm 3 . Biomarker analyses revealed O( 6)-methylguanine-DNA methyltransferasee 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], 4.6e6.4 months) and 10.0 months (95% CI, 7.9e11.7 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 < 0.0001), adjuvant treatment (P < 0.0001), and no treatmentassociated morbidity (P [ 0.0478). Increased EOR did not correlate with survival (P [ 0.5046), but correlated significantly with treatment-associated morbidity (P [ 0.0031).-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 Key words -Adjuvant treatment -Biomarker -Elderly -Glioblastoma multiforme -Outcome -Resection -Treatment-associated morbidity

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“…4,5 Elderly patients have frequently been excluded from clinical trials, 6 and those studies that do examine this population have demonstrated suboptimal survival outcomes. Chemotherapy (CT) alone, 8,9 radiotherapy (RT) alone, 10 and combined-modality therapy using CT and RT (CRT), 11,12 have all produced improved outcomes in select elderly patients. Chemotherapy (CT) alone, 8,9 radiotherapy (RT) alone, 10 and combined-modality therapy using CT and RT (CRT), 11,12 have all produced improved outcomes in select elderly patients.…”

Section: Introductionmentioning

confidence: 99%

“…4,5,7 Determining the ideal adjuvant treatment for elderly patients is further complicated by multiple treatment options. Chemotherapy (CT) alone, 8,9 radiotherapy (RT) alone, 10 and combined-modality therapy using CT and RT (CRT), 11,12 have all produced improved outcomes in select elderly patients. Age is just 1 of many factors clinicians may consider when choosing therapy for patients with GBM.…”

Section: Introductionmentioning

confidence: 99%

Patterns of care and predictors of adjuvant therapies in elderly patients with glioblastoma: An analysis of the National Cancer Data Base

Amsbaugh

Yusuf

Gaskins

et al. 2017

Cancer

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Analysis of Treatment Tolerance and Factors Associated with Overall Survival in Elderly Patients with Glioblastoma

Cited by 17 publications

References 31 publications

Gross Total vs. Subtotal Resection on Survival Outcomes in Elderly Patients With High-Grade Glioma: A Systematic Review and Meta-Analysis

Gross Total vs. Subtotal Resection on Survival Outcomes in Elderly Patients With High-Grade Glioma: A Systematic Review and Meta-Analysis

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

Patterns of care and predictors of adjuvant therapies in elderly patients with glioblastoma: An analysis of the National Cancer Data Base

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