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

Schwartz, Christoph; Romagna, Alexander; Stefanits, Harald; Zimmermann, Georg; Ladisich, Barbara; Geiger, Philipp; Rechberger, Julian S.; Winkler, Sophie; Weiß, Lukas; Fastner, Gerd; Trinka, Eugen; Weis, Serge; Spiegl-Kreinecker, Sabine; Steinbacher, Juergen; McCoy, Mark R.; Trenkler, Johannes; Gruber, Andreas J.; Jahromi, Behnam Rezai; Niemelä, Mika; Winkler, Peter; Thon, Niklas

doi:10.1016/j.wneu.2019.09.097

Cited by 10 publications

(5 citation statements)

References 35 publications

(97 reference statements)

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“…This was proved by intraoperative microscopic total excision in conjunction with postoperative radiology. This agrees with studies that favor maximum tumor resection as this is in favor with better survival and lower risk for mortality and morbidity [21][22][23][24][25][26][27].…”

Section: Discussionsupporting

confidence: 89%

Brain tumor surgery in the elderly: a single institution experience of short-term outcome—a retrospective case study

Tantawy

Nazim

2021

Egypt J Neurol Psychiatry Neurosurg

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Background There is an evolving concern in the management of brain tumors in the elderly. The number of elderly people (aged 65 years or more) increases progressively, and there is a considerable percent of brain tumors affecting this age group. Elderly people may have one or more chronic illnesses that may render cranial surgery of high risk for mortality and morbidity. This study was carried out to evaluate the short-term (30 days) outcome of brain tumor surgery in elderly patients. Results This is a single-institution retrospective study of elderly patients harboring brain tumors who were managed by surgery. The study included 31 patients between 2014 and 2019. Elective and emergency cases were included. The mean age for the study population was 68.29 years. The mean functional status using the Karnofsky Performance Scale (KPS) changed from 58.06 before surgery to 70 after surgery. Meningioma grade I and glioblastoma multiforme (GBM) were the most common neoplasms, 41.9 and 29%, respectively. There was a statistically significant relationship between the mortality and GBM (P value < 0.05) while there was no correlation with concomitant diseases, KPS, or extent of resection (P value > 0.05). Preoperative concomitant diseases were found in 16 patients. Mortality occurred in 11 cases (35.4%). Conclusions Old age by itself should not be a risk factor alone for increasing mortality or morbidity in cranial surgery for patients with brain tumors. Glioblastoma in old patients with poor KPS carries a significant risk for mortality. Further studies with a larger number of patients and inclusion of more variables are required.

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Section: Discussionsupporting

confidence: 89%

Brain tumor surgery in the elderly: a single institution experience of short-term outcome—a retrospective case study

Tantawy

Nazim

2021

Egypt J Neurol Psychiatry Neurosurg

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“…Higher KPS is an important predictive factor of survival according to some studies (29). In our study, higher KPS is associated with prolonged survival.…”

Section: Discussionsupporting

confidence: 69%

Predictors of survival in turkish patients with primary glioblastoma

Bilgin¹,

Duman²,

Altıntaş³

et al. 2021

Turkish Neurosurgery

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AIM: An increasing number of biomarkers of primary glioblastoma (GBM) have recently been described. We aimed to investigate the biological and clinical factors that affect survival in Turkish patients with primary GBM. MATERIAL and METHODS: The clinical and demographic data of all patients with primary GBM diagnosed between 2007 and 2016 were evaluated. In all the patients' pathological specimens, O6 methylguanine-DNA methyltransferase (MGMT) methylation and isocitrate dehydrogenase (IDH) 1 mutation were detected retrospectively by immunohistochemistry. Kaplan-Meier survival analysis, log-rank test, and multivariate analyses of the Cox hazard proportional model for all the variables were performed using the SPSS statistical package. The treatment details and other patient-related factors were identified, and their correlations were analyzed. RESULTS: We enrolled 137 primary GBM patients to the study. Median progression free survival (PFS) was 8.57 months (95% CI:6.8-9.5) and median overall survival (OS) was 12 months (95% CI:10.8-13.3). IDH-1 mutations were detected in 21 primary GBMs (15.3%). PFS was 15.43 ± 1.95 months. Survival rates were higher, but no statistically significant difference (p=0.074). MGMT methylation was detected in 40 primary GBMs (29.2%). OS and PFS of MGMT (+) cases were higher than MGMT(-) cases (p=0.001; p=0.001 respectively). Ki67 (%) measurement (10%-90%) average is 32.64 ± 16.56. No statistically significant between higher and lower ki67 levels (p=0.510, p=0.505 respectively). KPS (%) more than 70 at the time of diagnosis statistically significant longer median OS and PFS (p=0.001). PFS and OS were higher in all treatment modalities. CONCLUSION: The most important factors that affected survival were performance score, MGMT methylation status, systemic oncologic therapy, and IDH mutation in the Turkish population with primary GBM. We demonstrated that MGMT methylation and higher KPS levels were associated with significiantly longer OS and PFS.

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“…Thus, a decent approach to define appropriate treatment algorithms is necessary and first guidelines on the topic have been published [32,33], focusing on the efficacy of cytoreduction apart from GTR only paradigms. Although a benefit of GTR in GBM patients has been confirmed by many studies [34][35][36][37], data on the impact of EOR on outcome in elderly (≥ 65), often fragile patients are scarce and less specific, but favor resection over biopsy only protocols [4,8,10,12,38,39]. A survival benefit for any microsurgical glioma surgery compared to biopsy only in IDH-wildtype GBM patients -regardless of the extent of resection -has been reported [39,40] as well as a survival benefit for GTR compared to partial/subtotal resection and biopsy only in a recent study with a large cohort of GBM patients older than 65 years [8].…”

Section: Discussionmentioning

confidence: 99%

“…Only moderate effects of gross total resection (GTR) -especially compared to biopsy alone -on OS have been demonstrated in patients older than 65 years [5][6][7][8][9][10]. Considering this background any surgery-related morbidity in elderly GBM patients might mitigate the potential benefits of aggressive surgical treatment [8,[10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Surgeon experience in glioblastoma surgery of the elderly—a multicenter, retrospective cohort study

Pöppe

Machegger²,

Steinbacher³

et al. 2023

J Neurooncol

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Purpose To assess the impact of individual surgeon experience on overall survival (OS), extent of resection (EOR) and surgery-related morbidity in elderly patients with glioblastoma (GBM), we performed a retrospective case-by-case analysis. Methods GBM patients aged ≥ 65 years who underwent tumor resection at two academic centers were analyzed. The experience of each neurosurgeon was quantified in three ways: (1) total number of previously performed glioma surgeries (lifetime experience); (2) number of surgeries performed in the previous five years (medium-term experience) and (3) in the last two years (short-term experience). Surgeon experience data was correlated with survival (OS) and surrogate parameters for surgical quality (EOR, morbidity). Results 198 GBM patients (median age 73.0 years, median preoperative KPS 80, IDH-wildtype status 96.5%) were included. Median OS was 10.0 months (95% CI 8.0–12.0); median EOR was 89.4%. Surgery-related morbidity affected 19.7% patients. No correlations of lifetime surgeon experience with OS (P = .693), EOR (P = .693), and surgery-related morbidity (P = .435) were identified. Adjuvant therapy was associated with improved OS (P < .001); patients with surgery-related morbidity were less likely to receive adjuvant treatment (P = .002). In multivariable testing, adjuvant therapy (P < .001; HR = 0.064, 95%CI 0.028–0.144) remained the only significant predictor for improved OS. Conclusion Less experienced neurosurgeons achieve similar surgical results and outcome in elderly GBM patients within the setting of academic teaching hospitals. Adjuvant treatment and avoidance of surgery-related morbidity are crucial for generating a treatment benefit for this cohort.

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

Cited by 10 publications

References 35 publications

Brain tumor surgery in the elderly: a single institution experience of short-term outcome—a retrospective case study

Brain tumor surgery in the elderly: a single institution experience of short-term outcome—a retrospective case study

Predictors of survival in turkish patients with primary glioblastoma

Surgeon experience in glioblastoma surgery of the elderly—a multicenter, retrospective cohort study

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