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Outcome of glioblastoma resection in patients 80 years of age and older

  • Review Article - Brain Tumors
  • Published:
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Abstract

Objective

To evaluate the role and possible complications of tumor resection in the management of glioblastoma (GBM) in a series of patients 80 years of age and older with review of literature.

Methods

The authors retrospectively analyzed cases involving patients 80 years or older who underwent biopsy or initial resection of GBM at their hospital between 2007 and 2018. A total of 117 patients (mean age 82 years) met the inclusion criteria; 57 had resection (group A) and 60 had biopsy (group B). Functional outcomes and survival at follow-up were analyzed.

Results

Group A differed significantly from group B at baseline in having better WHO performance status, better ASA scores, more right-sided tumors, and no basal ganglia or “butterfly” gliomas. Nevertheless, 56% of group A patients had an ASA score of 3. Median survival was 9.5 months (95% CI 8–17 months) in group A, 4 months (95% CI 3.5–6 months) in group B, and 17.5 months (95% CI 12–24 months) in the 56% of group A patients treated with resection and Stupp protocol. Rates of postoperative neurologic and medical complications were almost identical in the 2 groups, but the rate of surgical site complications was substantially greater in group A (12% vs 5%). There was no significant difference in mean preoperative and postoperative KPS scores (group A).

Conclusions

In selected patients 80 years or older, radical removal of GBM was associated with acceptable survival and a low perioperative complication rate which is comparable to that of a biopsy. Although the median survival of the whole group was lower than reported for younger patients, a subgroup amenable to radical surgery and Stupp protocol achieved a median survival of 17.5 months.

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Abbreviations

ASA:

American Society of Anesthesiologists

EOR:

extent of resection

GBM:

glioblastoma

GTR:

gross-total resection

KPS:

Karnofsky Performance Status

STR:

subtotal resection

WHO:

World Health Organization

SEER:

Surveillance, Epidemiology and End Results

References

  1. Almenawer SA, Badhiwala JH, Alhazzani W, Greenspoon J, Farrokhyar F, Yarascavitch B, Algird A, Kachur E, Cenic A, Sharieff W, Klurfan P, Gunnarsson T, Ajani O, Reddy K, Singh SK, Murty NK (2015) Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis. Neuro-Oncology 17(6):868–881. https://doi.org/10.1093/neuonc/nou349

    Article  PubMed  PubMed Central  Google Scholar 

  2. Batchelor TT, Dorfman MV, Hunter DJ (2005) Epidemiology of primary brain tumors. In: Black PM, Loeffler JS (eds) Cancer of the nervous system. Lippincott Williams & Wilkins, Philadelphia, pp 1–13

    Google Scholar 

  3. Benson AB, Pregler JP, Bean JA, Rademaker AW, Eshler B, Anderson K (1991) Oncologists’ reluctance to accrue patients onto clinical trials: an Illinois Cancer Center study. Journal of Clinical Oncology 9(11):2067–2075. https://doi.org/10.1200/JCO.1991.9.11.2067

    Article  PubMed  Google Scholar 

  4. Bloch O, Han SJ, Cha S, Sun MZ, Aghi MK, McDermott MW, Berger MS, Parsa AT (2012) Impact of extent of resection for recurrent glioblastoma on overall survival. J Neurosurg 117(6):1032–1038. https://doi.org/10.3171/2012.9.JNS12504

    Article  PubMed  Google Scholar 

  5. Brandes A, Fiorentino MV (1998) Treatment of High-Grade Gliomas in the Elderly. Oncology 55(1):1–6. https://doi.org/10.1159/000011827

    Article  CAS  PubMed  Google Scholar 

  6. Brandes AA, Monfardini S (2003) The treatment of elderly patients with high-grade gliomas. Semin Oncol 30(6 Suppl 19):58–62. https://doi.org/10.1053/j.seminoncol.2003.11.025

    Article  PubMed  Google Scholar 

  7. Cabantog AM, Bernstein M (1994) Complications of First Craniotomy for Intra-Axial Brain Tumour. Can J Neurol Sci 21(3):213–218. https://doi.org/10.1017/S0317167100041184

    Article  CAS  PubMed  Google Scholar 

  8. D’Amico RS, Cloney MB, Sonabend AM, Zacharia B, Nazarian MN, Iwamoto FM, Sisti MB, Bruce JN, McKhann GM (2015) The Safety of Surgery in Elderly Patients with Primary and Recurrent Glioblastoma. World Neurosurg 84(4):913–919. https://doi.org/10.1016/j.wneu.2015.05.072

    Article  PubMed  Google Scholar 

  9. Dasenbrock HH, Liu KX, Devine CA, Chavakula V, Smith TR, Gormley WB, Dunn IF (2015) Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis. Neurosurg Focus 39(6):E12. https://doi.org/10.3171/2015.10.FOCUS15386

    Article  PubMed  Google Scholar 

  10. Ene CI, Cimino PJ, Fine HA, Holland EC (2020) Incorporating genomic signatures into surgical and medical decision-making for elderly glioblastoma patients. Neurosurg Focus 49(4):E12. https://doi.org/10.3171/2020.7.FOCUS20418

    Article  Google Scholar 

  11. Hanna C, Lawrie TA, Rogozińska E, Kernohan A, Jefferies S, Bulbeck H, Ali UM, Robinson T, Grant R (2020) Treatment of newly diagnosed glioblastoma in the elderly: a network meta-analysis. Cochrane Database Syst Rev 3(3):CD013261. https://doi.org/10.1002/14651858.CD013261.pub2

    Article  PubMed  Google Scholar 

  12. Ius T, Somma T, Altieri R, Angileri FF, Barbagallo GM, Cappabianca P, Certo F, Cofano F, D’Elia A, Della Pepa GM, Esposito V, Fontanella MM, Germanò A, Garbossa D, Isola M, La Rocca G, Maiuri F, Olivi A, Panciani PP et al (2020) Is age an additional factor in the treatment of elderly patients with glioblastoma? A new stratification model: an Italian Multicenter Study. Neurosurg Focus 49(4):E13. https://doi.org/10.3171/2020.7.FOCUS20420

    Article  PubMed  Google Scholar 

  13. Karsy M, Yoon N, Boettcher L, Jensen R, Shah L, MacDonald J, Menacho ST (2018) Surgical treatment of glioblastoma in the elderly: the impact of complications. J Neuro-Oncol 138(1):123–132. https://doi.org/10.1007/s11060-018-2777-9

    Article  Google Scholar 

  14. Laigle-Donadey F, Delattre J-Y (2006) Glioma in the elderly. Curr Opin Oncol 18(6). https://doi.org/10.1097/01.cco.0000245324.19411.19

  15. Lowry JK, Snyder JJ, Lowry PW (1998) Brain Tumors in the Elderly. Arch Neurol 55(7). https://doi.org/10.1001/archneur.55.7.922

  16. Lutterbach J, Bartelt S, Momm F, Becker G, Frommhold H, Ostertag C (2005) Is older age associated with a worse prognosis due to different patterns of care? Cancer 103(6):1234–1244. https://doi.org/10.1002/cncr.20895

    Article  PubMed  Google Scholar 

  17. Malmström A, Grønberg BH, Marosi C, Stupp R, Frappaz D, Schultz H, Abacioglu U, Tavelin B, Lhermitte B, Hegi ME, Rosell J, Henriksson R (2012) Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol 13(9):916–926. https://doi.org/10.1016/S1470-2045(12)70265-6

    Article  CAS  PubMed  Google Scholar 

  18. Mangiola A, Maira G, De Bonis P, Porso M, Pettorini B, Sabatino G, Anile C (2006) Glioblastoma Multiforme in the Elderly: A Therapeutic Challenge. J Neuro-Oncol 76(2):159–163. https://doi.org/10.1007/s11060-005-4711-1

    Article  CAS  Google Scholar 

  19. Menei P, Metellus P (2010) Traitement chirurgical des glioblastomes. Neurochirurgie 56(6). https://doi.org/10.1016/j.neuchi.2010.07.015

  20. Minniti G, Lombardi G, Paolini S (2019) Glioblastoma in Elderly Patients: Current Management and Future Perspectives. Cancers 11(3):336. https://doi.org/10.3390/cancers11030336

    Article  CAS  PubMed Central  Google Scholar 

  21. Moroney C, Perry DSTJR, Bilodeau D, Mueller C, Soliman H, Myrehaug S, Sahgal A, Tseng C-L, Tsao MN (2017) Hospitalizations in elderly glioblastoma patients. Ann Palliat Med 6(S2):S161–S169. https://doi.org/10.21037/apm.2017.06.02

    Article  PubMed  Google Scholar 

  22. Noorbakhsh A, Tang JA, Marcus LP, McCutcheon B, Gonda DD, Schallhorn CS, Talamini MA, Chang DC, Carter BS, Chen CC (2014) Gross-total resection outcomes in an elderly population with glioblastoma: a SEER-based analysis. J Neurosurg 120(1):31–39. https://doi.org/10.3171/2013.9.JNS13877

    Article  PubMed  Google Scholar 

  23. Oberheim Bush NA, Hervey-Jumper SL, Berger MS (2019) Management of Glioblastoma Present and Future. World Neurosurg 131:328–338. https://doi.org/10.1016/j.wneu.2019.07.044

    Article  PubMed  Google Scholar 

  24. Pérez-Larraya JG, Ducray F, Chinot O, Catry-Thomas I, Taillandier L, Guillamo J-S, Campello C, Monjour A, Cartalat-Carel S, Barrie M, Huchet A, Beauchesne P, Matta M, Mokhtari K, Tanguy M-L, Honnorat J, Delattre J-Y (2011) Temozolomide in Elderly Patients With Newly Diagnosed Glioblastoma and Poor Performance Status: An ANOCEF Phase II Trial. J Clin Oncol 29(22):3050–3055. https://doi.org/10.1200/JCO.2011.34.8086

    Article  CAS  Google Scholar 

  25. Piccirilli M, Bistazzoni S, Gagliardi FM, Landi A, Santoro A, Giangaspero F, Salvati M (2006) Treatment of Glioblastoma Multiforme in Elderly Patients. Clinico-therapeutic Remarks in 22 Patients Older than 80 Years. Tumori 92(2):98–103. https://doi.org/10.1177/030089160609200203

    Article  PubMed  Google Scholar 

  26. Ricard D, Idbaih A, Ducray F, Lahutte M, Hoang-Xuan K, Delattre J-Y (2012) Primary brain tumours in adults. Lancet 379(9830):432–446. https://doi.org/10.1016/S0140-6736(11)61346-9

    Article  Google Scholar 

  27. Tanaka S, Meyer FB, Buckner JC, Uhm JH, Yan ES, Parney IF (2013) Presentation, management, and outcome of newly diagnosed glioblastoma in elderly patients. J Neurosurg 118(4):786–798. https://doi.org/10.3171/2012.10.JNS112268

    Article  PubMed  Google Scholar 

  28. Vuorinen V, Hinkka S, Färkkilä M, Jääskeläinen J (2003) Debulking or biopsy of malignant glioma in elderly people – a randomised study. Acta Neurochir 145(1):5–10. https://doi.org/10.1007/s00701-002-1030-6

    Article  CAS  PubMed  Google Scholar 

  29. Yin A, Cai S, Dong Y, Zhang L, Liu B, Cheng J, Zhang X (2014) A meta-analysis of temozolomide versus radiotherapy in elderly glioblastoma patients. J Neuro-Oncol 116(2):315–324. https://doi.org/10.1007/s11060-013-1294-0

    Article  CAS  Google Scholar 

  30. Zouaoui S, Darlix A, Fabbro-Peray P, Mathieu-Daudé H, Rigau V, Fabbro M, Bessaoud F, Taillandier L, Ducray F, Bauchet F, Wager M, Faillot T, Capelle L, Loiseau H, Kerr C, Menei P, Duffau H, Figarella-Branger D, Chinot O et al (2014) Oncological patterns of care and outcomes for 265 elderly patients with newly diagnosed glioblastoma in France. Neurosurg Rev 37(3):415–424. https://doi.org/10.1007/s10143-014-0528-8

    Article  PubMed  Google Scholar 

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Acknowledgements

We are grateful to Anne Stanford, ELS, for English language editing. The authors thank the ARTC (Association Recherche contre les Tumeurs Cérébrales) for their help.

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Authors and Affiliations

  1. Pôle Neuroscience (Neurochirurgie), Centre Hospitalo-Universitaires de Toulouse, Université de Toulouse, Toulouse, France

    Mahamadou Niare, Clarissa Cavandoli, Victor Virak, Oumar Sacko, Saloua Charni & Franck-Emmanuel Roux

  2. UPS (Université Paul Sabatier), Toulouse, France

    Mahamadou Niare, Jacques Desrousseaux, Clarissa Cavandoli, Victor Virak, Oumar Sacko, Saloua Charni & Franck-Emmanuel Roux

  3. Centre de Recherche Cerveau et Cognition (CNRS; CerCo), Toulouse, France

    Mahamadou Niare, Saloua Charni & Franck-Emmanuel Roux

  4. Service de Neurochirurgie et CNRS (CERCO), Hôpital Pierre-Paul Riquet, F-31059, Toulouse, France

    Mahamadou Niare

  5. Service de Radiothérapie, Institut Universitaire du Cancer, Toulouse, France

    Jacques Desrousseaux

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  1. Mahamadou Niare
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Correspondence to Mahamadou Niare.

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Niare, M., Desrousseaux, J., Cavandoli, C. et al. Outcome of glioblastoma resection in patients 80 years of age and older. Acta Neurochir 164, 373–383 (2022). https://doi.org/10.1007/s00701-021-04776-5

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  • DOI: https://doi.org/10.1007/s00701-021-04776-5

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