Debulking or biopsy of malignant glioma in elderly people – a randomised study

Vuorinen, Ville; Hinkka, Susanna; Färkkilä, Markus; Jääskeläinen, Juha E.

doi:10.1007/s00701-002-1030-6

Cited by 332 publications

(212 citation statements)

References 10 publications

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“…The results indicated the survival benefit of resection (5.7 months) versus biopsy (2.8 months). Although, the study was unblinded and without adjuvant chemotherapy 11 . Chaichana et al compared 133 and 72 consecutive patients aged 65 years and older who underwent surgery and needle biopsy for intracranial primary (de novo) GBM and were retrospectively reviewed.…”

Section: Discussionmentioning

confidence: 99%

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Resection versus biopsy of glioblastomas in eloquent brain areas

Hrabálek¹,

Kalita²,

Vaverka³

et al. 2015

BIOMED PAP

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Aim. The aim of this study was to compare resection and biopsy of glioblastoma (GBM) in eloquent brain areas (EBA). Methods. This was a prospective evaluation of 38 patients with GBM in EBA. 22 were treated by surgical resection and 16 by biopsy. Preoperative KPS, neurological status and size of lesion on MRI were assessed. One week and three months postoperatively KPS, neurological status and Performance Status (PS) WHO were evaluated. Extent of resection (EOR) and overall survival (OS) were described. Overall mean age of the patients was 64.3 years, the mean lesion size in the resection group was 47.7 mm and in the biopsy group 51.0 mm. Results. Worsening or development of permanent neurological deficits 3 months after surgery were significantly lower in the resection group (23%), than the biopsy group (94%). In the resection group the median pre and postoperative KPS three months after surgery was 80.0. In the biopsy group the median pre and postoperative KPS was 68.1 one week after the procedure. In the resection group, 3 months after surgery, the median PS was 1, in the biopsy group one week after surgery the median PS was 2. The difference was statistically insignificant. The mean OS after resection was 12.2 months, and after biopsy 3.5 months. The difference was highly statistically significant. The mean EOR was 90%. Conclusion. This is the first prospective study, to our knowledge, that compares the results of resection and biopsy of primary GBM in EBA. For patients in good clinical condition with tumors in or near EBA, recommended is as radical resection of GBM as possible.

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Section: Discussionmentioning

confidence: 99%

“…Not only OS but also time of deterioration and quality of life are important outcome measures if we discuss fatal disease. Vuorinen et al suggested that there was 2.8 times higher risk for deterioration after biopsy than after craniotomy and resection 11 . Pereira et al used AC and somato-sensory evoked potentials (SSEPs).…”

Section: Discussionmentioning

confidence: 99%

Resection versus biopsy of glioblastomas in eloquent brain areas

Hrabálek¹,

Kalita²,

Vaverka³

et al. 2015

BIOMED PAP

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“…A recent small randomized trial included 23 patients aged greater than 65 years with malignant glioma assigned to only biopsy or resection with radiation therapy. 43) The median survival time was significantly longer in patients who underwent resection (5.6 months) than in those who underwent biopsy (2.8 months). In general, surgical treatment for elderly patients carries the risk of high mortality and morbidity.…”

Section: Discussionmentioning

confidence: 92%

Prognostic Factors in Elderly Patients With Supratentorial Malignant Gliomas

Kurimoto

Nagai

Kamiyama

et al. 2007

Neurol. Med. Chir.(Tokyo)

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The prognostic factors were retrospectively analyzed in 30 patients aged 70 years or over with supratentorial malignant gliomas treated by surgery in our hospital. The histological diagnosis was confirmed as grade 3 in 13 patients and grade 4 in 17. Seventeen patients received adjuvant radiation therapy. Only 10 patients underwent chemotherapy. Survival time was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from the Cox proportional hazards model. Univariate analysis showed preoperative Karnofsky performance status (KPS) score of 70 or greater and radiation therapy were significantly associated with longer survival. However, multivariate analysis revealed that preoperative KPS score of 70 or greater was the only independent prognostic factor and radiation therapy lost its significance due to selection bias. Neurological deterioration and medical complications occurred in six and seven patients, respectively. Performance status rather than histological grade is the key prognostic factor in elderly patients with supratentorial malignant gliomas. Patients with good preoperative KPS score should be aggressively treated with extensive resection and radiotherapy.

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“…However, little evidence for these therapies is available as most studies investigated only small or retrospective patient cohorts [18][19][20][21][22][23][24][25]. Furthermore, availability of stereotactic radiotherapy or radiosurgery and financial resources of health care systems account for significant differences in use between countries and even national regions.…”

Section: Introductionmentioning

confidence: 99%

Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes

Hundsberger

Hottinger²,

Roelcke

et al. 2015

J Neurooncol

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Despite moderate improvements in outcome of glioblastoma after first-line treatment with chemoradiation recent clinical trials failed to improve the prognosis of recurrent glioblastoma. In the absence of a standard of care we aimed to investigate institutional treatment strategies to identify similarities and differences in the pattern of care for recurrent glioblastoma. We investigated re-treatment criteria and therapeutic pathways for recurrent glioblastoma of eight neuro-oncology centres in Switzerland having an established multidisciplinary tumour-board conference. Decision algorithms, differences and consensus were analysed using the objective consensus methodology. A total of 16 different treatment recommendations were identified based on combinations of eight different decision criteria. The set of criteria implemented as well as the set of treatments offered was different in each centre. For specific situations, up to 6 different treatment recommendations were provided by the eight centres. The only wide-range consensus identified was to offer best supportive care to unfit patients. A majority recommendation was identified for non-operable large early recurrence with unmethylated MGMT promoter status in the fit patients: here bevacizumab was offered. In fit patients with late recurrent non-operable MGMT promoter methylated glioblastoma temozolomide was recommended by most. No other majority recommendations were present. In the absence of strong evidence we identified few consensus recommendations in the treatment of recurrent glioblastoma. This contrasts the limited availability of single drugs and treatment modalities. Clinical situations of greatest heterogeneity may be suitable to be addressed in clinical trials and second opinion referrals are likely to yield diverging recommendations.

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Debulking or biopsy of malignant glioma in elderly people – a randomised study

Cited by 332 publications

References 10 publications

Resection versus biopsy of glioblastomas in eloquent brain areas

Resection versus biopsy of glioblastomas in eloquent brain areas

Prognostic Factors in Elderly Patients With Supratentorial Malignant Gliomas

Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes

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