gms | German Medical Science

Objective: Elderly patients constitute an expanding part of our society and, with increasing life expectancy, a significantly improved quality of life is expected even in advanced age. Glioblastoma is more common in older patients, but they are still often withheld from intense treatment due to concerns about presumed worse tolerance and worse prognosis in comparison with younger patients. Our retrospective observational study aimed to investigate the risks and benefits from a re-resection in recurrent glioblastoma of elderly patients.

Methods: We included a cohort of 39 elderly patients (>70 years) with a second resection as treatment option in the event of tumor recurrence. A causal inference model was built by multiple non- and semiparametric models, which was used to identify matched patients from our elderly GBM database. The matched cohorts were analyzed by a Cox-regression model. Additionally, data on co-morbidities, hemato-oncological courses during chemotherapy, neurological outcome, anesthetic- and surgical complications were evaluated.

Results: Due to the fact, that patients were selected based on an equal propensity score given by the causal inference model, demographics and first-line therapy were similar (p>0.05). The mean age in both groups was 70 years (70.2 ReR vs 69.9 Ctr). The Cox-regression analysis showed a significant survival benefit (Hazard Ratio: 0.6 CI95% 0.36-0.9 p-value=0.0427) for the re-resected group (18.0 months CI95% 13.97–23.2 months) compared to the group without re-resection (10.1 months CI95% 8.09–20.9 months) and a significant improvement of the neurological performance status 3-months and 6-months after recurrence was found in the re-resected group (p<0.05). No differences in the co-morbidities or hemato-oncological courses during chemotherapy could be detected. Anesthetic- and surgical complications were rare and comparable to the complication rate of the first resection.

Conclusion: Re-resection is an acceptable treatment option in the recurrent state of a glioblastoma. The evaluation of the medical status and the ability to undergo general anesthesia of elderly patients needs to be done in close interdisciplinary consultation. If these requirements are achieved, elderly patients benefit from a re-resection.