gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

The Glioblastoma multiforme of the elderly: the prognostic impact of resection on survival

Meeting Abstract

  • C. Ewelt - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf
  • M. Goeppert - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf
  • W. Stummer - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf
  • H.-J. Steiger - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf
  • M. Sabel - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.09-08

doi: 10.3205/09dgnc237, urn:nbn:de:0183-09dgnc2370

Published: May 20, 2009

© 2009 Ewelt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: According to recent developments the best treatment options for glioblastoma multiforme (GBM) patients consist in maximal safe resection and additional adjuvant treatment with radiotherapy (RT) and alkylating chemotherapy (CHX). These options have been evaluated for populations with a median age of approximately 58 years. We therefore addressed the issue, whether elderly patients (>65y) could also benefit from cytoreductive surgery (CS) and adjuvant treatment using alkylating chemotherapy.

Methods: 96 patients (>65 y, median 70.7 y) diagnosed with primary GBM (resection or biopsy) were retrospectively divided into Group A (n=29) treated with surgery alone (Biopsy, B, n=17, CS n=12), Group B (n=36) surgery and radiation (B n=18, CS n=18) and group C (n=31) surgery, RT and Chx (B n=4, CS n=27). Progression free survival (PFS) and Overall survival (OS) were determined in each group and correlated to age, Karnofsky performance score (KPS) and extent of resection (biopsy [B], partial [PR] and complete resection [CR], respectively. Quality of life was measured by standard evaluation score.

Results: For the whole population PFS and OAS were 3.6 m and 5.6 m respectively. PFS and OAS for groups A/B/C were 2.2m/3.7m/7.3m (p=0.00) and 2.2m/5.1m/13.9m (p=0.00), respectively. Median age for groups A/B/C was 73.1y/70.6y/68.5y and median KPS was 60/70/80. Age (<75, >75) was correlated with OAS (6,4m / 3.2 m, p=0.01). KPS (<70, >70) was correlated with PFS 2.5m/3.9m (p=0.006) and OAS 3.3m/7.1m (p=0.000). Extent of resection (biopsy, PR and CR) correlated with PFS (2.4m/3.6m/8.8m, p=0,001) and OAS (2.5m/7.0m/13.6m, p=0,001), respectively.

Conclusions: Our study clearly demonstrates that elderly GBM patients benefit from aggressive treatment protocols including cytoreductive surgery, radiation therapy and chemotherapy. Treatment decisions in this population are obviously influenced by KPS and age. The most impressive outcome predictor in this population was the extent of surgical resection. Best quality of life was associated with age < 75 years and KPS > 70. In summary, elderly GBM patients should not be per se excluded from intensive treatment protocols.