To resect or not to resect? Risks and benefits of surgery in older patients with glioblastoma

Abstract

Introduction: Glioblastoma multiforme (GBM) has a peak incidence in patients older than 65 years. The aim of the present study is to evaluate the impact of surgical strategy on short- and long-term outcomes of older GBM patients.

Methods: A total of 273 older patients (65-84 years) from 2006 to 2014 were operated in our neurosurgical center. The study endpoints were postoperative change of the Karnofsky performance status scale (KPS) and overall survival (OS). The extent of resection (EOR) was categorized into gross total resection (GTR, >95% by volume), subtotal resection (STR, ≤95%) and stereotactic biopsy (SB). The subgroup analyses were performed in two age groups dichotomized at 75 years.

Results: EOR was associated with the risk of postoperative decline of KPS only in patients aged ≥75 years (p = 0.0002/p = 0.0014 for SB vs. GTR and STR respectively), but not in the age group 65-74 years (p = 0.1511/p = 0.2701). The mean OS in the whole cohort was 8.4 months (±9.6). GTR was superior to SB with regards to OS (p < 0.0001/p = 0.0017). STR revealed a more favorable OS than SB only in patients aged 65-74 years (p = 0.0077). Multivariate analysis confirmed that only GTR was independently associated with OS (p < 0.0001/p = 0.013).

Conclusions: GTR may provide a better OS even in GBM patients with advanced age. STR still shows a benefit over SB for OS in older patients <75 years. For older individuals, SB presents a safer option with regards to the risk of postoperative morbidity and should be favored in cases, when the surgical alternative is limited to STR.

Keywords: Extent of resection; Geriatric; Glioblastoma.