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Journal of Neuro-Oncology

, Volume 140, Issue 2, pp 385–391 | Cite as

One decade of glioblastoma multiforme surgery in 342 elderly patients: what have we learned?

  • Dieter Henrik HeilandEmail author
  • Gerrit Haaker
  • Ralf Watzlawick
  • Daniel Delev
  • Waseem Masalha
  • Pamela Franco
  • Marcia Machein
  • Ori Staszewski
  • Oliver Oelhke
  • Nils Henrik Nicolay
  • Oliver Schnell
Clinical Study

Abstract

Introduction

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 functional and oncological outcome in surgical treatment of elderly patients.

Materials and methods

A total of 342 elderly patients aged ≥ 65 years were retrospectively analyzed in our neurosurgical center. Surgical therapy, adjuvant treatment, overall survival (OS) and functional outcome using Karnofsky performance scale (KPS) and Neurological assessment of neuro-oncology-score were analyzed.

Results

The median age at GBM diagnosis was 73.4 (IQR 9.28) years. Median overall survival was 7.5 (CI 95% 6.0–9.1) months and median preoperative or postoperative KPS was 80 (IQR 20). Surgical resection was performed in 216 (63.2%) patients, in 125 patients (36.5%) patients a stereotactic biopsy was performed. The median OS was significantly higher in patients with gross total resection (GTR) compared to partial resection and biopsy (10.8 months; CI 95% 9.5–12.3). Patients with combined radio- and chemo-therapy (RCT) showed significant longer OS, particularly MGMT-negative GBM. Higher preoperative KPS was found to be associated with improved overall survival.

Conclusion

GTR and adjuvant combined RCT provides benefits for overall survival in elderly patients. Therapy decision should be made in regard to preoperative functional status instead of biological age.

Keywords

Glioblastoma multiforme Elderly patients NANO-score Radiochemotherapy 

Notes

Funding

DHH was funded by the German Cancer Society (SGTII), Müller-Fahnenberg Stiftung.

Compliance with ethical standards

Conflict of interest

Authors declare no conflict of interest.

Supplementary material

11060_2018_2964_MOESM1_ESM.docx (62 kb)
Supplementary material 1 (DOCX 61 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018
corrected publication September 2018

Authors and Affiliations

  • Dieter Henrik Heiland
    • 1
    • 4
  • Gerrit Haaker
    • 1
    • 4
  • Ralf Watzlawick
    • 1
    • 4
  • Daniel Delev
    • 1
    • 4
  • Waseem Masalha
    • 1
    • 4
  • Pamela Franco
    • 1
    • 4
  • Marcia Machein
    • 1
    • 4
  • Ori Staszewski
    • 2
    • 4
  • Oliver Oelhke
    • 3
    • 4
  • Nils Henrik Nicolay
    • 3
    • 4
  • Oliver Schnell
    • 1
    • 4
  1. 1.Department of Neurosurgery, Medical CenterUniversity of FreiburgFreiburgGermany
  2. 2.Institute of Neuropathology, Medical CenterUniversity of FreiburgFreiburgGermany
  3. 3.Radiation Clinic, Medical CenterUniversity of FreiburgFreiburgGermany
  4. 4.Faculty of MedicineUniversity of FreiburgFreiburgGermany

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