Article
Oncological and functional evaluation of 432 elderly patients with glioblastoma multiforme
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Authors
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Gerrit Haaker
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
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Ralf Watzlawick
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
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Dieter Henrik Heiland
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
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Waseem Masalha
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
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Pamela Franco
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
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Daniel Delev
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
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Oliver Schnell
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Surgical treatment for elderly patients (>65 years) with glioblastoma multiforme (GBM) is often restricted due to comorbidities, reduced clinical status or fear of treatment complications. Since elderly patients are often underrepresented in clinical trials, the aim of our study was to evaluate the impact of age in surgical and oncological outcome in a large cohort of 432 glioblastoma patients.
Methods: In this retrospective analysis we included GBM patients ≥65 years, surgically treated between 2008 and 2017 at our institution. Comprehensive analysis was performed included overall survival (OS), extent of resection, MGMT-promoter methylation status, different treatment modalities, functional outcome (NANO) and Karnofsky Performance Score (KPS). Survival analysis was performed by uni- and multivariate Cox-regression model. The alpha-level was determined to 5% to achieve statistical significance with a power of 80%.
Results: A total of 432 elderly GBM patients were included. 271 patients underwent surgical resection, 161 a stereotactic biopsy. Median age at diagnosis was 73.8 years. In a cox-regression model, age was not significantly associated with OS. Patients who received GTR showed an increased OS irrespective of their biological age.
Better preoperative KPS was associated with longer OS. (11.2 vs. 7.9 months, p=<0.001). Gross total resection (GTR) with adjuvant radiochemotherapy (RCT) was associated with longer OS. Patients with unmethylated GBM showed a significant longer OS with radiochemotherapy (RCT) compared to radiotherapy (RT) alone.
In case of a GTR, no significant survival benefit was detected for combined RCT in comparison to chemotherapy (CT) alone (15.4 vs. 13.8 months, p=0.09), whereas combined RCT shows longer OS after partial resection and biopsy (11.2 vs. 5.8 months, p=<0.001).
Conclusion: GTR is associated with better OS in elderly patients with GBM and good functional status (KPS ≥ 70). Combined adjuvant RCT becomes especially important for patients with residual tumor. For patients with KPS <70 a resection can be performed in carefully selected patients where GTR is feasible. Otherwise, a stereotactical biopsy with maximal possible adjuvant therapy should be taken into consideration. In elderly patients treatment selection should be made according to functional status instead of biological age.
