Gross-total resection outcomes in an elderly population with glioblastoma: a SEER-based analysis

Noorbakhsh, Abraham; Tang, Jessica; Marcus, Logan P.; McCutcheon, Brandon A.; Gonda, David; Schallhorn, Craig S; Talamini, Mark A.; Chang, David C.; Carter, Bob S.; Chen, Clark C.

doi:10.3171/2013.9.jns13877

Cited by 112 publications

(83 citation statements)

References 23 publications

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“…Furthermore, we defined ''extent of resection'' based on the surgical codes provided by SEER that are most in keeping with GTR (i.e., ''Radical, total, gross resection'', ''resection of lobe of brain'', ''Gross total resection of lobe of brain''), and STR (i.e., ''Local excision'', ''excisional biopsy'', or, ''Subtotal resection''). This is consistent with previous work by ourselves [35] and others [41]. However, SEER does not offer a standardized or recommended means of defining these variables.…”

Section: Discussionsupporting

confidence: 89%

Pediatric choroid plexus tumors: epidemiology, treatments, and outcome analysis on 202 children from the SEER database

et al. 2014

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Choroid plexus papillomas (CPPs) and carcinomas (CPCs) are rare neoplasms that affect mostly children. Due to their rarity, their epidemiology and outcomes are incompletely understood. The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program is a well-established population-based group of registries that collects and publishes cancer incidence and survival data representing approximately 28 % of the US population. SEER-STAT v8.1.2 was used to identify patients with ICD-O-3 codes for choroid plexus tumors in patients aged 0-19. Demographics, initial treatment, and follow-up data were collected. Statistical methods including Kaplan-Meier curves, log rank tests, and Cox proportional hazards regression were used to estimate associations between independent variables and survival. The SEER registries contained 107 CPPs (2004-2010) and 95 CPCs (1978-2010). Median follow-up was 38 and 40 months, respectively. More than 75 % of CPCs were diagnosed before the age of 5 years, versus 48 % for CPPs. Sixty-five percent of CPCs and 57 % of CPPs occurred in males. In both groups at least 90 % of children underwent surgical resection. Gross total resection (GTR) was achieved in 67.0 % of CPCs and 63.6 % of CPPs. Almost 17 % of CPCs were treated with radiation versus only 0.9 % of CPPs. More than 98 % of patients with CPP were alive at the last follow-up, versus 62 % of CPC patients. For CPC, surgery was significantly associated with increased overall survival, but contrary to previous reports, extent of surgical resection was not associated with survival. Age, sex, race, and radiation treatment also had no effect on survival. This report, using the SEER datasets, corroborates many findings of previous smaller studies on CPTs. CPC occurs in younger children, with a male predominance, and a much worse prognosis than CPP. As such, these tumors have been treated aggressively with high rates of GTR and radiation treatment. Despite these treatments, overall survival for CPC remains poor.

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Section: Discussionsupporting

confidence: 89%

Pediatric choroid plexus tumors: epidemiology, treatments, and outcome analysis on 202 children from the SEER database

et al. 2014

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“…Interestingly, the survival times in that study (5.1 months for SRT and 5.6 months for HRT) were closer to the survival estimates of the patients in this analysis who were treated with alternatives to SRT. The relatively short survivals in the Roa study may be explained by the limited proportion of enrolled patients (<15%) who had undergone complete surgical resections, since the extent of surgery has been shown to positively affect survival (25). In addition, this trial was closed early due to slow accrual and was not sufficiently powered to conclude that the two treatments were truly statistically equivalent.…”

Section: Groups -----------------------------------------------------mentioning

confidence: 99%

“…A possible explanation for this discrepancy is that, in this population-based retrospective analysis, patients treated with these abbreviated therapies possibly had worse prognostic factors (i.e., extent of surgery and performance status) compared with the patients enrolled in the German NOA-08 and Nordic clinical trials. To clarify, although the extent of surgery was beyond the scope of this analysis, in 2014 Noorbakhsh et al (25) published a SEER-based population study of elderly GBM patients, analyzing the extent of resection and the outcomes. They found that, of the 3,631 patients aged ≥75 years, only 24.2% had undergone complete resection, 24.1% had undergone partial resection, 17.2% local excision or biopsy, 32.7% had received no surgery and 1.8% was unknown.…”

Section: Groups -----------------------------------------------------mentioning

confidence: 99%

A Surveillance, Epidemiology and End Results-Medicare data analysis of elderly patients with glioblastoma multiforme: Treatment patterns, outcomes and cost

Burton

Ugiliweneza

Woo

et al. 2015

Molecular and Clinical Oncology

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Abstract. The Surveillance, Epidemiology and End Results (SEER) database was used to determine the treatment patterns, outcomes and cost of therapy in elderly patients with glioblastoma multiforme (GBM). The SEER-Medicare linked database was used to identify patients aged >66 years with GBM diagnosed between 1997 and 2009. The patients were stratified by initial treatment following diagnostic surgery (resection or biopsy) into 6 groups as follows: No treatment, standard radiation therapy (SRT) with and without concurrent temozolomide (TMZ), hypofractionated RT (HRT) with and without concurrent TMZ, or TMZ alone. The 3,759 patients identified had a median age of 74 years (range, 66-97 years). A total of ~48% of the patients received SRT without TMZ; ~10% received SRT with concurrent TMZ; ~29% received no treatment; ~10% received HRT without TMZ; ~1% received HRT with TMZ; and <1% received TMZ alone. Untreated patients had a median survival of 2 months (range, 0-89 months). Patients treated with SRT with and without concurrent TMZ had a median survival of 11 and 9 months, respectively (P=0.01). Patients treated with HRT with and without TMZ or TMZ alone had a median survivals of 3 months [adjusted hazard ratio (AHR)=0.48; 95% confidence interval (CI): 0.36-0.66], 4 months (AHR=0.55; 95% CI: 0.49-0.62) and 6 months (AHR=0.43; 95% CI: 0.29-0.62), respectively. The median post-surgery total treatment cost for patients receiving HRT with and without TMZ or TMZ alone was 63,915, 42,834 and 48,298 USD, respectively. Standard RT with concurrent TMZ was associated with improved survival, even in patients aged >75 years. HRT with and without concurrent TMZ and TMZ alone improved survival compared to the no treatment group. Therefore, in certain cases, HRT or TMZ alone may be more cost-effective, with similar survival outcomes. The various treatment options highlight the need for geriatric assessment tools to aid in therapeutic decision making.

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“…The high rate of GTR in this cohort of elderly patients may also support this notion, because nationwide studies have shown older patients to receive GTR significantly less frequently than younger patients. 31 In addition, many patients in this study were enrolled in a variety of clinical trials, such as those evaluating combination therapies and immunotherapy. As a result, the varying treatment and follow-up protocols may have affected patient survival.…”

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confidence: 99%

Glioblastoma in the elderly: the effect of aggressive and modern therapies on survival

Babu¹,

Komisarow²,

Agarwal³

et al. 2016

JNS

114

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abbreviatioNs EOR = extent of resection; GBM = glioblastoma; GTR = gross-total resection; HR = hazard ratio; KPS = Karnofsky Performance Scale; RT = radiotherapy; SRS = stereotactic radiosurgery; STR = subtotal resection; TMZ = temozolomide. obJective The prognosis of elderly patients with glioblastoma (GBM) is universally poor. Currently, few studies have examined postoperative outcomes and the effects of various modern therapies such as bevacizumab on survival in this patient population. In this study, the authors evaluated the effects of various factors on overall survival in a cohort of elderly patients with newly diagnosed GBM. methods A retrospective review was performed of elderly patients (≥ 65 years old) with newly diagnosed GBM treated between 2004 and 2010. Various characteristics were evaluated in univariate and multivariate stepwise models to examine their effects on complication risk and overall survival. results A total of 120 patients were included in the study. The median age was 71 years, and sex was distributed evenly. Patients had a median Karnofsky Performance Scale (KPS) score of 80 and a median of 2 neurological symptoms on presentation. The majority (53.3%) of the patients did not have any comorbidities. Tumors most frequently (43.3%) involved the temporal lobe, followed by the parietal (35.8%), frontal (32.5%), and occipital (15.8%) regions. The majority (57.5%) of the tumors involved eloquent structures. The median tumor size was 4.3 cm. Every patient underwent resection, and 63.3% underwent gross-total resection (GTR). The vast majority (97.3%) of the patients received the postoperative standard of care consisting of radiotherapy with concurrent temozolomide. The majority (59.3%) of patients received additional agents, most commonly consisting of bevacizumab (38.9%). The median survival for all patients was 12.0 months; 26.7% of patients experienced long-term (≥ 2-year) survival. The extent of resection was seen to significantly affect overall survival; patients who underwent GTR had a median survival of 14.1 months, whereas those who underwent subtotal resection had a survival of 9.6 months (p = 0.038). Examination of chemotherapeutic effects revealed that the use of bevacizumab compared with no bevacizumab (20.1 vs 7.9 months, respectively; p < 0.0001) and irinotecan compared with no irinotecan (18.0 vs 9.7 months, respectively; p = 0.027) significantly improved survival. Multivariate stepwise analysis revealed that older age (hazard ratio coNclusioN This study has demonstrated that GTR confers a modest survival benefit on elderly patients with GBM, suggesting that safe maximal resection is warranted. In addition, bevacizumab significantly increased the overall survival of these elderly patients with GBM; older age and preoperative KPS score also were significant prognostic factors. Although elderly patients with GBM have a poor prognosis, they may experience enhanced survival after the administration of the standard of care and the use of additional chemotherapeutics such as bevaciz...

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Gross-total resection outcomes in an elderly population with glioblastoma: a SEER-based analysis

Cited by 112 publications

References 23 publications

Pediatric choroid plexus tumors: epidemiology, treatments, and outcome analysis on 202 children from the SEER database

Pediatric choroid plexus tumors: epidemiology, treatments, and outcome analysis on 202 children from the SEER database

A Surveillance, Epidemiology and End Results-Medicare data analysis of elderly patients with glioblastoma multiforme: Treatment patterns, outcomes and cost

Glioblastoma in the elderly: the effect of aggressive and modern therapies on survival

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