gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Decision for extent of surgical resection in elderly glioblastoma

Entscheidung zum Ausmaß der chirurgischen Resektion bei älteren Patienten mit einem Glioblastom

Meeting Abstract

  • presenting/speaker Yahya Ahmadipour - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Oliver Müller - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Philipp Dammann - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Daniela Pierscianek - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Marvin Darkwah Oppong - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Agnieszka Grzywotz - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP072

doi: 10.3205/19dgnc410, urn:nbn:de:0183-19dgnc4108

Veröffentlicht: 8. Mai 2019

© 2019 Ahmadipour et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults with peak incidence in patients older than 65 years. These patients are mostly underrepresented in clinical trials and often undertreated due to concomitant diseases. Recently, different therapeutic approaches for elderly patients with GBM were discussed. To date, there is no defined standard treatment. The aim of the present study is to evaluate the impact of surgical strategy on short- and long-term outcome of elderly GBM patients.

Methods: A total of 273 elderly patients (age range 65–84 years, 121 [44.3%] females) from 2006 to 2014 were operated in our neurosurgical center and included to final analysis. The study endpoints were postoperative change of the Karnofsky performance scale (KPS) and overall survival (OS). The patients were analysed in different subgroups depending on extent of resection (gross total resection [GTR, >95% by volume], subtotal resection [STR, ≤ 95% by volume] and stereotactic biopsy [SB]) and age (65–74 vs 75–84 years).

Results: The number of patients with GTR and SB in the cohort was almost equal (106 [38.8%] vs 105 [38.5%]), STR was performed in 62 cases (22.7%). The mean KPS decrease after surgery was 5.8% (±12). SB was associated with lower postoperative decrease of KPS only in patients aged ≥75 years (p=0.0002/p=0.0014 for GTR/STR), but not in the age group 65–74 years (p=0.1511/p=0.2701). The mean OS was 8.4 months (±9.6). In both age groups, GTR was superior to SB with regard to OS (p<0.0001/p=0.0017). STR showed better OS than SB only in patients aged 65–74 years (p=0.0077 vs p=0.8272 in patients aged ≥75 years). Multivariate analysis confirmed positive impact of GTR on OS independently from preoperative KPS and patients’ age (p<0.0001).

Conclusion: GTR may provide a better OS even in GBM patients with advanced age. STR still shows a benefit over SB for OS in elderly patients <75 years. For older individuals, SB presents a safer option with regard to risk of postoperative morbidity and should be favored in cases, when surgical alternative is limited to STR.