Annals of Surgical Oncology

, Volume 18, Issue 1, pp 239–245 | Cite as

Supratentorial Glioblastoma Multiforme: The Role of Surgical Resection Versus Biopsy Among Older Patients

  • Kaisorn L. Chaichana
  • Tomas Garzon-Muvdi
  • Scott Parker
  • Jon D. Weingart
  • Alessandro Olivi
  • Richard Bennett
  • Henry Brem
  • Alfredo Quiñones-Hinojosa
Neuro-Oncology

Abstract

Background

The peak incidence of glioblastoma multiforme (GBM) occurs in those aged 65 years and older. However, studies on this patient group remain limited. The goal of this study is to evaluate the efficacy of surgery versus biopsy for older patients with these lesions.

Methods

133 and 72 consecutive patients aged 65 years and older who underwent surgery and needle biopsy for intracranial primary (de novo) GBM between 1997 and 2007 were retrospectively reviewed. Among these patients, 40 who underwent surgical resection were matched with 40 who underwent needle biopsy alone for factors consistently shown to be associated with survival [age, Karnofsky Performance Scale (KPS) indexing, eloquent involvement, radiation, temozolomide]. Survival was expressed as estimated Kaplan–Meier plots, and log-rank analysis was used to compare survival curves.

Results

Mean ± standard deviation age was 73 ± 5 years, and median survival was 4.9 months. There were no significant differences in perioperative outcomes among patients who underwent surgical resection versus needle biopsy. Patients who underwent resection had median survival of 5.7 months as compared with 4.0 months for patients who underwent needle biopsy (P = 0.02). Likewise, for patients aged 70 years and older, median survival was 4.5 months for 26 patients who underwent surgical resection as compared with 3.0 months for 26 patients who underwent needle biopsy (P = 0.03).

Conclusion

This study demonstrates that older patients tolerate aggressive surgery without increased surgery-related morbidity and have prolonged survival as compared with similar patients undergoing needle biopsy. These findings may help guide treatment decisions for patients, their families, and their physicians.

References

  1. 1.
    Wrensch M, Minn Y, Chew T, Bondy M, Berger MS. Epidemiology of primary brain tumors: current concepts and review of the literature. Neuro Oncol. 2002;4:278–99.PubMedGoogle Scholar
  2. 2.
    Hegi ME, Diserens AC, Gorlia T, Hamou MF, de Tribolet N, Weller M, et al. MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med. 2005;10:997–1003.CrossRefGoogle Scholar
  3. 3.
    Barnholtz-Sloan JS, Williams VL, Maldonado JL, Shahani D, Stockwell HG, Chamberlain M, et al. Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma. J Neurosurg. 2008;4:642–8.Google Scholar
  4. 4.
    Iwamoto FM, Cooper AR, Reiner AS, Nayak L, Abrey LE. Glioblastoma in the elderly: the Memorial Sloan–Kettering Cancer Center experience (1997–2007). Cancer. 2009;16:3758–66.CrossRefGoogle Scholar
  5. 5.
    Brem H, Piantadosi S, Burger PC, Walker M, Selker R, Vick NA, et al. Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent gliomas. The Polymer-brain Tumor Treatment Group. Lancet. 1995;8956:1008–12.CrossRefGoogle Scholar
  6. 6.
    Chang EL, Yi W, Allen PK, Levin VA, Sawaya RE, Maor MH. Hypofractionated radiotherapy for elderly or younger low-performance status glioblastoma patients: outcome and prognostic factors. Int J Radiat Oncol Biol Phys. 2003;2:519–28.CrossRefGoogle Scholar
  7. 7.
    Keles GE, Lundin DA, Lamborn KR, Chang EF, Ojemann G, Berger MS. Intraoperative subcortical stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients. J Neurosurg. 2004;3:369–75.Google Scholar
  8. 8.
    Chang SM, Parney IF, McDermott M, Barker FG, II, Schmidt MH, Huang W, et al. Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. J Neurosurg. 2003;6:1175–81.Google Scholar
  9. 9.
    Chaichana K, Parker S, Olivi A, Quinones-Hinojosa A. A proposed classification system that projects outcomes based on preoperative variables for adult patients with glioblastoma multiforme. J Neurosurg. 2010;112:997–1004.Google Scholar
  10. 10.
    Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 2001;2:190–8.Google Scholar
  11. 11.
    Nitta T, Sato K. Prognostic implications of the extent of surgical resection in patients with intracranial malignant gliomas. Cancer. 1995;11:2727–31.CrossRefGoogle Scholar
  12. 12.
    Dutta D, Vanere P, Gupta T, Munshi A, Jalali R. Factors influencing activities of daily living using FIM-FAM scoring system before starting adjuvant treatment in patients with brain tumors: results from a prospective study. J Neurooncol. 2009;94:103–10.Google Scholar
  13. 13.
    McGirt MJ, Chaichana KL, Gathinji M, Attenello FJ, Than K, Olivi A, et al. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg. 2009;1:156–62.Google Scholar
  14. 14.
    Social Security Death Index Database, vol 2009, Rootsweb. http://ssdi.rootsweb.ancestry.com.
  15. 15.
    Altman DG. Practical statistics for medical research. New York: Chapman & Hall/CRC; 1991.Google Scholar
  16. 16.
    Claes A, Idema AJ, Wesseling P. Diffuse glioma growth: a guerilla war. Acta Neuropathol (Berl). 2007;5:443–58.CrossRefGoogle Scholar
  17. 17.
    Dandy WE. Removal of right cerebral hemisphere for certain tumors with hemiplegia. JAMA. 1928;90:823–5.Google Scholar
  18. 18.
    Grant R, Metcalfe SE. Biopsy versus resection for malignant glioma. Cochrane Database Syst Rev. 2005;CD002034.Google Scholar
  19. 19.
    Hess KR. Extent of resection as a prognostic variable in the treatment of gliomas. J Neurooncol. 1999;3:227–31.CrossRefGoogle Scholar
  20. 20.
    Nazzaro JM, Neuwelt EA. The role of surgery in the management of supratentorial intermediate and high-grade astrocytomas in adults. J Neurosurg. 1990;3:331–44.Google Scholar
  21. 21.
    Quigley MR, Maroon JC. The relationship between survival and the extent of the resection in patients with supratentorial malignant gliomas. Neurosurgery. 1991;3:385–8; discussion 388–9.Google Scholar
  22. 22.
    McGirt MJ, Chaichana KL, Gathinji M, Attenello FJ, Than K, Olivi A, et al. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg. 2009;110:156–62.Google Scholar
  23. 23.
    Laws ER, Parney IF, Huang W, Anderson F, Morris AM, Asher A, et al. Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project. J Neurosurg. 2003;3:467–73.Google Scholar
  24. 24.
    Brandes AA, Franceschi E, Tosoni A, Benevento F, Scopece L, Mazzocchi V, et al. Temozolomide concomitant and adjuvant to radiotherapy in elderly patients with glioblastoma: correlation with MGMT promoter methylation status. Cancer. 2009;15:3512–8.CrossRefGoogle Scholar
  25. 25.
    Iwamoto FM, Reiner AS, Nayak L, Panageas KS, Elkin EB, Abrey LE. Prognosis and patterns of care in elderly patients with glioma. Cancer. 2009;23:5534–40.CrossRefGoogle Scholar
  26. 26.
    Kimple RJ, Grabowski S, Papez M, Collichio F, Ewend MG, Morris DE. Concurrent temozolomide and radiation, a reasonable option for elderly patients with glioblastoma multiforme? Am J Clin Oncol. 2010;33:265–70.Google Scholar
  27. 27.
    Alonso M, Hamelin R, Kim M, Porwancher K, Sung T, Parhar P, et al. Microsatellite instability occurs in distinct subtypes of pediatric but not adult central nervous system tumors. Cancer Res. 2001;5:2124–8.Google Scholar
  28. 28.
    Rickert CH, Strater R, Kaatsch P, Wassmann H, Jurgens H, Dockhorn-Dworniczak B, et al. Pediatric high-grade astrocytomas show chromosomal imbalances distinct from adult cases. Am J Pathol. 2001;4:1525–32.Google Scholar
  29. 29.
    Sung T, Miller DC, Hayes RL, Alonso M, Yee H, Newcomb EW. Preferential inactivation of the p53 tumor suppressor pathway and lack of EGFR amplification distinguish de novo high grade pediatric astrocytomas from de novo adult astrocytomas. Brain Pathol. 2000;2:249–59.Google Scholar
  30. 30.
    Brandes A, Fiorentino MV. Treatment of high-grade gliomas in the elderly. Oncology. 1998;1:1–6.CrossRefGoogle Scholar
  31. 31.
    Lowry JK, Snyder JJ, Lowry PW. Brain tumors in the elderly: recent trends in a Minnesota cohort study. Arch Neurol. 1998;7:922–8.CrossRefGoogle Scholar
  32. 32.
    McGirt MJ, Mukherjee D, Chaichana KL, Than KD, Weingart JD, Quinones-Hinojosa A. Association of surgically acquired motor and language deficits on overall survival after resection of glioblastoma multiforme. Neurosurgery. 2009;3:463–9; discussion 469–70.Google Scholar
  33. 33.
    Wu GN, Ford JM, Alger JR. MRI measurement of the uptake and retention of motexafin gadolinium in glioblastoma multiforme and uninvolved normal human brain. J Neurooncol. 2006;1:95–103.CrossRefGoogle Scholar
  34. 34.
    McGirt MJ, Than KD, Weingart JD, Chaichana KL, Attenello FJ, Olivi A, et al. Gliadel (BCNU) wafer plus concomitant temozolomide therapy after primary resection of glioblastoma multiforme. J Neurosurg. 2009;3:583–8.Google Scholar
  35. 35.
    Nimsky C, Ganslandt O, Buchfelder M, Fahlbusch R. Intraoperative visualization for resection of gliomas: the role of functional neuronavigation and intraoperative 1.5 T MRI. Neurol Res. 2006;5:482–7.CrossRefGoogle Scholar
  36. 36.
    Sanai N, Mirzadeh Z, Berger MS. Functional outcome after language mapping for glioma resection. N Engl J Med. 2008;1:18–27.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Kaisorn L. Chaichana
    • 1
  • Tomas Garzon-Muvdi
    • 1
  • Scott Parker
    • 1
  • Jon D. Weingart
    • 1
  • Alessandro Olivi
    • 1
  • Richard Bennett
    • 1
  • Henry Brem
    • 1
  • Alfredo Quiñones-Hinojosa
    • 1
  1. 1.The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Departments of Neurosurgery, Oncology and MedicineThe Johns Hopkins Hospital, Johns Hopkins University School of MedicineBaltimoreUSA

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