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

Journal of Neuro-Oncology volume 140, pages 385–391 (2018)Cite this article

A Correction to this article was published on 10 September 2018

This article has been updated

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.

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Change history

  • 10 September 2018

    There was a typo in the third author’s name in the initial online publication.

References

  1. Young JS, Chmura SJ, Wainwright DA, Yamini B, Peters KB, Lukas RV (2017) Management of glioblastoma in elderly patients. J Neurol Sci 380:250–255

    Article  CAS  PubMed  Google Scholar 

  2. Stupp R, Dietrich P-Y, Kraljevic SO et al (2002) Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol 20:1375–1382

    Article  CAS  PubMed  Google Scholar 

  3. Khurana V, Jain S, Smee R, Cook R, Dobes M, Shadbolt B, Smith S, Dexter M (2011) Increasing incidence of glioblastoma multiforme and meningioma, and decreasing incidence of Schwannoma (2000–2008): findings of a multicenter Australian study. Surg Neurol Int. https://doi.org/10.4103/2152-7806.90696

    Article  PubMed  PubMed Central  Google Scholar 

  4. Morgan ER, Norman A, Laing K, Seal MD (2017) Treatment and outcomes for glioblastoma in elderly compared with non-elderly patients: a population-based study. Curr Oncol. https://doi.org/10.3747/co.24.3424

    Article  PubMed  PubMed Central  Google Scholar 

  5. Minniti G, De Sanctis V, Muni R et al (2009) Hypofractionated radiotherapy followed by adjuvant chemotherapy with temozolomide in elderly patients with glioblastoma. J Neuro-Oncol 91:95–100

    Article  CAS  Google Scholar 

  6. 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 

  7. Harris G, Jayamanne D, Wheeler H et al (2017) Survival outcomes of elderly patients with glioblastoma multiforme in their 75th year or older treated with adjuvant therapy. Int J Radiat Oncol Biol Phys 98:802–810

    Article  PubMed  Google Scholar 

  8. Amsbaugh MJ, Yusuf MB, Gaskins J, Burton EC, Woo SY (2017) Patterns of care and predictors of adjuvant therapies in elderly patients with glioblastoma: an analysis of the national cancer database. Cancer. https://doi.org/10.1002/cncr.30730

    Article  PubMed  Google Scholar 

  9. Perry JR, Laperriere N, O’Callaghan CJ et al (2017) Short-course radiation plus temozolomide in elderly patients with glioblastoma. N Engl J Med 376:1027–1037

    Article  CAS  PubMed  Google Scholar 

  10. Tsang DS, Khan L, Perry JR, Soliman H, Sahgal A, Keith JL, Mainprize TG, Das S, Zhang L, Tsao MN (2015) Survival outcomes in elderly patients with glioblastoma. Clin Oncol. https://doi.org/10.1016/j.clon.2014.11.026

    Article  Google Scholar 

  11. Wen PY, Macdonald DR, Reardon DA et al (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28:1963–1972

    Article  PubMed  Google Scholar 

  12. Nayak L, Deangelis LM, Brandes AA et al (2017) The neurologic assessment in neuro-oncology (NANO) scale: a tool to assess neurologic function for integration into the response assessment in neuro-oncology (RANO) criteria. Neuro-Oncology 19:625–635

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hegi ME, Diserens A-C, Gorlia T et al (2005) MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 352:997–1003

    Article  CAS  PubMed  Google Scholar 

  14. Brandes AA, Franceschi E, Tosoni A, Benevento F, Scopece L, Mazzocchi V, Bacci A, Agati R, Calbucci F, Ermani M (2009) Temozolomide concomitant and adjuvant to radiotherapy in elderly patients with glioblastoma: correlation with MGMT promoter methylation status. Cancer 115:3512–3518

    Article  CAS  PubMed  Google Scholar 

  15. Malmström A, Grønberg BH, Marosi C et al (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 13:916–926

    Article  CAS  PubMed  Google Scholar 

  16. Minniti G, Salvati M, Arcella A, Buttarelli F, D’Elia A, Lanzetta G, Esposito V, Scarpino S, Maurizi Enrici R, Giangaspero F (2011) Correlation between O6-methylguanine-DNA methyltransferase and survival in elderly patients with glioblastoma treated with radiotherapy plus concomitant and adjuvant temozolomide. J Neuro-Oncol 102:311–316

    Article  CAS  Google Scholar 

  17. Reifenberger G, Hentschel B, Felsberg J et al (2012) Predictive impact of MGMT promoter methylation in glioblastoma of the elderly. Int J Cancer 131:1342–1350

    Article  CAS  PubMed  Google Scholar 

  18. Wick W, Platten M, Meisner C et al (2012) Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Oncol 13:707–715

    Article  CAS  PubMed  Google Scholar 

  19. Chaichana KLKK, Chaichana KLKK, Olivi A, Weingart JD, Bennett R, Brem H, Quinones-Hinojosa A, Quiñones-Hinojosa A (2011) Surgical outcomes for older patients with glioblastoma multiforme: preoperative factors associated with decreased survival. Clinical article. J Neurosurg 114:587–594

    Article  PubMed  Google Scholar 

  20. Chaichana KL, Garzon-Muvdi T, Parker S, Weingart JD, Olivi A, Bennett R, Brem H, Quiñones-Hinojosa A (2011) Supratentorial glioblastoma multiforme: the role of surgical resection versus biopsy among older patients. Ann Surg Oncol 18(1):239–245. https://doi.org/10.1245/s10434-010-1242-6

    Article  PubMed  Google Scholar 

  21. Oszvald Á, Güresir E, Setzer M, Vatter H, Senft C, Seifert V, Franz K (2012) Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age. J Neurosurg 116:357–364

    Article  PubMed  Google Scholar 

  22. Almenawer SA, Badhiwala JH, Alhazzani W et al (2015) Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis. Neuro-Oncology 17:868–881

    Article  PubMed  PubMed Central  Google Scholar 

  23. Babu R, Komisarow JM, Agarwal VJ et al (2016) Glioblastoma in the elderly: the effect of aggressive and modern therapies on survival. J Neurosurg. https://doi.org/10.3171/2015.4.JNS142200

    Article  PubMed  Google Scholar 

  24. Lorimer CF, Saran F, Chalmers AJ, Brock J (2016) Glioblastoma in the elderly—how do we choose who to treat? J Geriatr Oncol https://doi.org/10.1016/j.jgo.2016.07.005

    Article  PubMed  Google Scholar 

  25. Gately L, Collins A, Murphy M, Dowling A (2016) Age alone is not a predictor for survival in glioblastoma. J Neuro-Oncol. https://doi.org/10.1007/s11060-016-2194-x

    Article  Google Scholar 

  26. Zanello M, Roux A, Ursu R et al (2017) Recurrent glioblastomas in the elderly after maximal first-line treatment: does preserved overall condition warrant a maximal second-line treatment? On the Behalf of the Club de Neuro-Oncologie of the Société Française de Neurochirurgie. J Neuro-Oncol. https://doi.org/10.1007/s11060-017-2573-y

    Article  Google Scholar 

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Funding

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

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Author notes

  1. Dieter Henrik Heiland and Gerrit Haaker have contributed equally to this work.

Affiliations

  1. Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany

    Dieter Henrik Heiland, Gerrit Haaker, Ralf Watzlawick, Daniel Delev, Waseem Masalha, Pamela Franco, Marcia Machein & Oliver Schnell

  2. Institute of Neuropathology, Medical Center, University of Freiburg, Freiburg, Germany

    Ori Staszewski

  3. Radiation Clinic, Medical Center, University of Freiburg, Freiburg, Germany

    Oliver Oelhke & Nils Henrik Nicolay

  4. Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Dieter Henrik Heiland, Gerrit Haaker, Ralf Watzlawick, Daniel Delev, Waseem Masalha, Pamela Franco, Marcia Machein, Ori Staszewski, Oliver Oelhke, Nils Henrik Nicolay & Oliver Schnell

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  1. Dieter Henrik Heiland
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Correspondence to Dieter Henrik Heiland.

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The original version of this article has been revised: The third author’s name has been corrected.

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Heiland, D.H., Haaker, G., Watzlawick, R. et al. One decade of glioblastoma multiforme surgery in 342 elderly patients: what have we learned?. J Neurooncol 140, 385–391 (2018). https://doi.org/10.1007/s11060-018-2964-8

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  • DOI: https://doi.org/10.1007/s11060-018-2964-8

Keywords

  • Glioblastoma multiforme
  • Elderly patients
  • NANO-score
  • Radiochemotherapy