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Is surgical resection useful in elderly newly diagnosed glioblastoma patients? Outcome evaluation and prognostic factors assessment

  • Original Article - Brain Tumors
  • Published:
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ASTRACT

Background

The incidence of glioblastoma among elderly patients is constantly increasing. The value of radiation therapy and concurrent/adjuvant chemotherapy has been widely assessed. So far, the role of surgery has not been thoroughly investigated. The study aimed to evaluate safety and impact of several entities of surgical resection on outcome of elderly patients with newly diagnosed glioblastoma treated by a multimodal approach.

Methods

Patients ≥ 65 years, underwent surgery were included. The extent of surgical resection (EOR) was defined as complete resection (CR = 100%), gross total resection (GTR = 90–99%), sub-total resection (STR = 78–90%), partial resection (PR = 30–78%), and biopsy. After surgery, all patients received adjuvant radiotherapy (60/2 Gy fraction) with concomitant/adjuvant temozolomide chemotherapy.

Results

From March 2004 to December 2015, 178 elderly with a median age of 71 years (range 65–83 years) were treated. CR was obtained in 8 (4.5%), GTR in 63 (35.4%), STR in 46 (25.8%), PR in 16 (9.0%), and biopsy in 45 (25.3%). RT was started in all patients, concurrent/adjuvant CHT in 149 (83.7%) and 132 (74.2%). The median follow-up time was 12.2 months (range 0.4–50.4 months). The median, 1- and 2-year progression-free survival was 8.9 months (95%CI 7.8–100 months), 32.0 ± 3.5%, and 12.9 ± 2.6%. The median, 1- and 2-year overall survival were 12.2 (95%CI 11.3–13.1 months), 51.1 ± 3.7%, and 16.3 ± 2.9%. Tumor location, extent of resection, and neurological status after surgery statistically affected survival (p ≪ 0.01).

Conclusion

Maximal surgical resection is safe and feasible in elderly patients with influence on survival. A preoperative evaluation has to be carried out.

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Authors and Affiliations

  1. Neurosurgical Oncology Department, Humanitas Cancer Center and Research Hospital, Rozzano (Milan), Italy

    Federico Pessina, Marco Conti Nibali, Francesco Costa & Lorenzo Bello

  2. Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Rozzano, Italy

    Pierina Navarria, Luca Cozzi, Elena Clerici, Giulio Carta & Marta Scorsetti

  3. Department of Biomedical Sciences, Humanitas University, Rozzano, Italy

    Luca Cozzi, Matteo Simonelli, Armando Santoro & Marta Scorsetti

  4. Consultant of Neurosurgical Oncology Department, Humanitas Cancer Center and Research Hospital, Rozzano, Italy

    Roberta Rudà

  5. Hematology and Oncology Department, Humanitas Cancer Center and Research Hospital, Rozzano, Italy

    Matteo Simonelli & Armando Santoro

  6. University of Milan, Milan, Italy

    Lorenzo Bello

Authors
  1. Federico Pessina
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  2. Pierina Navarria
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Corresponding author

Correspondence to Federico Pessina.

Ethics declarations

This study was based on a retrospective analysis of treatment charts and received approval by local Ethical Committee.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

This article is part of the Topical Collection on Brain Tumors

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Pessina, F., Navarria, P., Cozzi, L. et al. Is surgical resection useful in elderly newly diagnosed glioblastoma patients? Outcome evaluation and prognostic factors assessment. Acta Neurochir 160, 1779–1787 (2018). https://doi.org/10.1007/s00701-018-3599-4

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  • DOI: https://doi.org/10.1007/s00701-018-3599-4

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