Risks and Benefits of Glioblastoma Resection in Older Adults: A Retrospective Austrian Multicenter Study

Christoph Schwartz; Alexander Romagna; Harald Stefanits; Georg Zimmermann; Barbara Ladisich; Philipp Geiger; Julian Rechberger; Sophie Winkler; Lukas Weiss; Gerd Fastner; Eugen Trinka; Serge Weis; Sabine Spiegl-Kreinecker; Jürgen Steinbacher; Mark McCoy; Trenkler Johannes; Andreas Gruber; Behnam Rezai Jahromi; Mika Niemelä; Peter A Winkler; Niklas Thon

doi:10.1016/j.wneu.2019.09.097

Risks and Benefits of Glioblastoma Resection in Older Adults: A Retrospective Austrian Multicenter Study

World Neurosurg. 2020 Jan:133:e583-e591. doi: 10.1016/j.wneu.2019.09.097. Epub 2019 Sep 24.

Authors

Christoph Schwartz¹, Alexander Romagna², Harald Stefanits³, Georg Zimmermann⁴, Barbara Ladisich², Philipp Geiger², Julian Rechberger², Sophie Winkler³, Lukas Weiss⁵, Gerd Fastner⁶, Eugen Trinka⁷, Serge Weis⁸, Sabine Spiegl-Kreinecker³, Jürgen Steinbacher⁹, Mark McCoy⁹, Trenkler Johannes¹⁰, Andreas Gruber³, Behnam Rezai Jahromi¹¹, Mika Niemelä¹¹, Peter A Winkler², Niklas Thon¹²

Affiliations

¹ Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria. Electronic address: c.schwartz@salk.at.
² Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
³ Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
⁴ Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria.
⁵ Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
⁶ Department of Radiotherapy and Radio-Oncology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
⁷ Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
⁸ Division of Neuropathology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
⁹ Division of Neuroradiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
¹⁰ Institute of Neuroradiology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
¹¹ Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
¹² Department of Neurosurgery, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.

PMID: 31561040
DOI: 10.1016/j.wneu.2019.09.097

Abstract

Objective: To assess the prognostic profile, clinical outcome, treatment-associated morbidity, and treatment burden of elderly patients with glioblastoma (GBM) undergoing microsurgical tumor resection as part of contemporary treatment algorithms.

Methods: We retrospectively identified patients with GBM ≥65 years of age who were treated by resection at 2 neuro-oncology centers. Survival was assessed by Kaplan-Meier analyses; log-rank tests identified prognostic factors.

Results: The study population included 160 patients (mean age, 73.1 ± 5.1 years), and the median contrast-enhancing tumor volume was 31.0 cm³. Biomarker analyses revealed O(6)-methylguanine-DNA methyltransferase-promoter methylation in 62.7% and wild-type isocitrate dehydrogenase in 97.5% of tumors. The median extent of resection (EOR) was 92.3%, surgical complications were noted in 10.0% of patients, and the median postoperative hospitalization period was 8 days. Most patients (60.0%) received adjuvant radio-/chemotherapy. The overall treatment-associated morbidity was 30.6%. The median progression-free and overall survival were 5.4 months (95% confidence interval [CI], 4.6-6.4 months) and 10.0 months (95% CI, 7.9-11.7 months). The strongest predictors for favorable outcome were patient age ≤73.0 years (P = 0.0083), preoperative Karnofsky Performance Status Scale score ≥80% (P = 0.0179), postoperative modified Rankin Scale score ≤1 (P < 0.0001), adjuvant treatment (P < 0.0001), and no treatment-associated morbidity (P = 0.0478). Increased EOR did not correlate with survival (P = 0.5046), but correlated significantly with treatment-associated morbidity (P = 0.0031).

Conclusions: Clinical outcome for elderly patients with GBM remains limited. Nonetheless, the observed treatment-associated morbidity and treatment burden were moderate in the patients, and patient age and performance status remained the strongest predictors for survival. The risks and benefits of tumor resection in the age of biomarker-adjusted treatment concepts require further prospective evaluation.

Keywords: Adjuvant treatment; Biomarker; Elderly; Glioblastoma multiforme; Outcome; Resection; Treatment-associated morbidity.

Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Austria
Brain Neoplasms / mortality
Brain Neoplasms / pathology
Brain Neoplasms / surgery*
Female
Glioblastoma / mortality
Glioblastoma / pathology
Glioblastoma / surgery*
Humans
Male
Neurosurgical Procedures*
Prognosis
Retrospective Studies
Risk Factors
Treatment Outcome