Artikel
Stereotactic biopsy in elderly patients: Risk assessment and impact on treatment decision
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Autoren
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Stephanie G. Kellermann
- Klinik und Poliklinik für Allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
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Christina A. Hamisch
- Klinik und Poliklinik für Allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
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Vanessa Hafkemeyer
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
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Daniel Rueß
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
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Stefan J. Grau
- Klinik und Poliklinik für Allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
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Maximilian I. Ruge
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: To evaluate feasibility and risk profile of stereotactic biopsy (SB) in elderly patients and to analyze its impact upon treatment decision.
Method: In this single center retrospective analysis we identified all patients aged ≥ 70 years receiving SB in a defined period between March 2011 and August 2015. We documented age, gender, Karnofsky Performance Status (KPS), histology, co-morbidity (by CHA2DS2-VASc Score) and use of anticoagulation. We then scrutinized feasibility, diagnostic yield, procedural complications (mortality, transient and permanent morbidity), time as in-patient and the overall therapeutic consequence. For correlational analysis regarding outcome Chi-Square, Mann-Whitney rank sum test and binary regression were used.
Results: One hundred and fourty-nine patients were included. In 148 patients SB was successfully performed. Median age was 74 (70-86) years, gender distribution was male in 58.1% and median KPS was 80 (30-100). Pathological diagnosis was conclusive in 96.6% revealing neoplastic lesions in 90.5 % (high-grade glioma 62.8%, lymphoma 17.6%, metastasis 5.4%, low-grade glioma 2.0% and other tumors 2.7%) and non-neoplastic lesions in 6.1%. Median CHA2DS2-VASc Score was 4 (1-9); 41.2% received anticoagulation and duration of inpatient-stay was 9.5 (2-30) days. Procedure-related mortality was 0%, transient morbidity was seen in 18 patients (7.4%) and permanent morbidity in four patients (2.7%; aggravation of preoperative symptoms (n=3); decreased level of consciousness (n=1)). Adjuvant disease specific therapy was initiated in 112/148 (75.7%) patients. Complication rate was only influenced by age ≥ 75 (p=0.027). Decision against disease-specific therapy was influenced by age ≥ 75 (p=0.028) as well as pre- and postoperative KPS <70 (p= 0.038 and p<0.0001 respectively).
Conclusions: These data demonstrate that stereotactic biopsy in elderly patients is feasible, safe and supports treatment decision-making. Younger patients (< 75 years) with independent status (KPS ≥ 70) showed a significantly higher probability of receiving adjuvant disease-specific therapy and lower complication rates, while with increasing age indication for SB should be made on a case-by-case basis.
