Artikel
Should recurrent malignant glioma be operated in the elderly?
Sollten Rezidive maligner Gliome beim älteren Patienten operiert werden?
Suche in Medline nach
Autoren
Veröffentlicht: | 4. Mai 2005 |
---|
Gliederung
Text
Objective
The indication for surgical treatment of recurrent glioma is controversial. Usually, the decision is based on age, neurological condition prior to surgery and time interval between initial surgery and tumour recurrence. We retrospectively compared the surgical outcome of patients with malignant gliomas younger and older than 60 years in order to evaluate whether elderly patients benefit from recurrent surgery.
Methods
42 malignant glioma patients (28 males, 14 females; 7 WHO°III, 35 WHO°IV) underwent surgery for recurrent tumour growth between 1995 and 1999. Surgical outcome (survival and time interval with Karnofsky ≥70) was compared between 31 patients younger and 11 patients older than 60 years. 29/31 patients (<60y) and 7/11 patients (≥60y) had a Karnofsky index ≥70 prior to recurrent surgery. Time interval between initial and recurrent surgery ranged between 4.3–67.2 months (median 16.5; n=6 WHO°III) and 1.5–51.7 months (median 9.4; n=25 WHO°IV) for the younger age group and 1.6 months (n=1 WHO°III) and 4.5–41.0 months (median 8.7; n=10 WHO°IV) for the older age group.
Results
24/31 patients <60y and 10/11 patients ≥60y had an equal or better neurological outcome after recurrent surgery. 22/31 patients <60y and 10/11 patients ≥60y additionally received adjuvant treatment. The survival was 0.4–46.5 months (median 6.8) for 31 patients <60y and 1.2–22.7 months (median 5.0) for 11 patients ≥60y, respectively. 5/31 received surgery for a second tumour recurrence after a time interval of 3.2–27.4 months, median 4.9 month (survival after second operation 1.4–10.6 months – median 5.5). 27/31 patient <60y and 7/11 patients ≥60y maintained a Karnofsky ≥70 for a time interval of 0.3 – 33.0 months (median 5.8) and 1.0–12.4 months (median 3.2), respectively. Total survival after initial surgery was 14.8–113.7 months (median 27.2; <60y) and 6.6 months (≥60y) for glioma WHO°III and 7.1–57.3 months (median 17.5; <60y) and 8.5–63.7 months (median 15.4; ≥60y) for glioma WHO°IV.
Conclusions
Patients with recurrent malignant gliomas in good initial neurological condition may profit from surgical and adjuvant treatment. Although older patients usually demonstrated an unfavourable outcome, surgery may be an option in certain patients in good clinical condition.