Cargando…
Surgical Management of Malignant Glioma in the Elderly
BACKGROUND: The median age for diagnosis of glioblastoma is 64 years and the incidence rises with increasing age to a peak at 75-84 years. As the total number of high-grade glioma patients is expected to increase with an aging population, neuro-oncological surgery faces new treatment challenges, esp...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9181439/ https://www.ncbi.nlm.nih.gov/pubmed/35692808 http://dx.doi.org/10.3389/fonc.2022.900382 |
_version_ | 1784723773349429248 |
---|---|
author | Klingenschmid, Julia Krigers, Aleksandrs Kerschbaumer, Johannes Thomé, Claudius Pinggera, Daniel Freyschlag, Christian F. |
author_facet | Klingenschmid, Julia Krigers, Aleksandrs Kerschbaumer, Johannes Thomé, Claudius Pinggera, Daniel Freyschlag, Christian F. |
author_sort | Klingenschmid, Julia |
collection | PubMed |
description | BACKGROUND: The median age for diagnosis of glioblastoma is 64 years and the incidence rises with increasing age to a peak at 75-84 years. As the total number of high-grade glioma patients is expected to increase with an aging population, neuro-oncological surgery faces new treatment challenges, especially regarding aggressiveness of the surgical approach and extent of resection. In the elderly, aspects like frailty and functional recovery time have to be taken into account before performing surgery. MATERIAL & METHODS: Patients undergoing surgery for malignant glioma (WHO grade III and IV) at our institution between 2015 and 2020 were compiled in a centralized tumor database and analyzed retrospectively. Karnofsky Performance Scale (KPS) and Clinical Frailty Scale (CFS) were used to determine functional performance pre- and postoperatively. Overall survival (OS) was compared between age groups of 65-69 years, 70-74 years, 75-79 years, 80-84 years and >85 years in view of extent of resection (EOR). Furthermore, we performed a literature evaluation focusing on surgical treatment of newly diagnosed malignant glioma in the elderly. RESULTS: We analyzed 121 patients aged 65 years and above (range 65 to 88, mean 74 years). Mean overall survival (OS) was 10.35 months (SD = 11.38). Of all patients, only a minority (22.3%) received tumor biopsy instead of gross total resection (GTR, 61.2%) or subtotal resection (STR, 16.5%). Postoperatively, 52.9% of patients were treated according to the Stupp protocol. OS differed significantly between extent of resection (EOR) groups (4.0 months after biopsy vs. 8.3 after STR vs. 13.8 after GTR, p < 0.05 and p < 0.001 correspondingly). No significant difference was observed regarding EOR across different age groups. CONCLUSION: GTR should be the treatment of choice also in elderly patients with malignant glioma as functional outcome and survival after surgery are remarkably better compared to less aggressive treatment. Elderly patients who received GTR of high-grade gliomas survived significantly longer compared to patients who underwent biopsy and STR. Age seems to have little influence on overall survival in selected surgically extensive treated patients, but high preoperative functional performance is mandatory. |
format | Online Article Text |
id | pubmed-9181439 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-91814392022-06-10 Surgical Management of Malignant Glioma in the Elderly Klingenschmid, Julia Krigers, Aleksandrs Kerschbaumer, Johannes Thomé, Claudius Pinggera, Daniel Freyschlag, Christian F. Front Oncol Oncology BACKGROUND: The median age for diagnosis of glioblastoma is 64 years and the incidence rises with increasing age to a peak at 75-84 years. As the total number of high-grade glioma patients is expected to increase with an aging population, neuro-oncological surgery faces new treatment challenges, especially regarding aggressiveness of the surgical approach and extent of resection. In the elderly, aspects like frailty and functional recovery time have to be taken into account before performing surgery. MATERIAL & METHODS: Patients undergoing surgery for malignant glioma (WHO grade III and IV) at our institution between 2015 and 2020 were compiled in a centralized tumor database and analyzed retrospectively. Karnofsky Performance Scale (KPS) and Clinical Frailty Scale (CFS) were used to determine functional performance pre- and postoperatively. Overall survival (OS) was compared between age groups of 65-69 years, 70-74 years, 75-79 years, 80-84 years and >85 years in view of extent of resection (EOR). Furthermore, we performed a literature evaluation focusing on surgical treatment of newly diagnosed malignant glioma in the elderly. RESULTS: We analyzed 121 patients aged 65 years and above (range 65 to 88, mean 74 years). Mean overall survival (OS) was 10.35 months (SD = 11.38). Of all patients, only a minority (22.3%) received tumor biopsy instead of gross total resection (GTR, 61.2%) or subtotal resection (STR, 16.5%). Postoperatively, 52.9% of patients were treated according to the Stupp protocol. OS differed significantly between extent of resection (EOR) groups (4.0 months after biopsy vs. 8.3 after STR vs. 13.8 after GTR, p < 0.05 and p < 0.001 correspondingly). No significant difference was observed regarding EOR across different age groups. CONCLUSION: GTR should be the treatment of choice also in elderly patients with malignant glioma as functional outcome and survival after surgery are remarkably better compared to less aggressive treatment. Elderly patients who received GTR of high-grade gliomas survived significantly longer compared to patients who underwent biopsy and STR. Age seems to have little influence on overall survival in selected surgically extensive treated patients, but high preoperative functional performance is mandatory. Frontiers Media S.A. 2022-05-26 /pmc/articles/PMC9181439/ /pubmed/35692808 http://dx.doi.org/10.3389/fonc.2022.900382 Text en Copyright © 2022 Klingenschmid, Krigers, Kerschbaumer, Thomé, Pinggera and Freyschlag https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Oncology Klingenschmid, Julia Krigers, Aleksandrs Kerschbaumer, Johannes Thomé, Claudius Pinggera, Daniel Freyschlag, Christian F. Surgical Management of Malignant Glioma in the Elderly |
title | Surgical Management of Malignant Glioma in the Elderly |
title_full | Surgical Management of Malignant Glioma in the Elderly |
title_fullStr | Surgical Management of Malignant Glioma in the Elderly |
title_full_unstemmed | Surgical Management of Malignant Glioma in the Elderly |
title_short | Surgical Management of Malignant Glioma in the Elderly |
title_sort | surgical management of malignant glioma in the elderly |
topic | Oncology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9181439/ https://www.ncbi.nlm.nih.gov/pubmed/35692808 http://dx.doi.org/10.3389/fonc.2022.900382 |
work_keys_str_mv | AT klingenschmidjulia surgicalmanagementofmalignantgliomaintheelderly AT krigersaleksandrs surgicalmanagementofmalignantgliomaintheelderly AT kerschbaumerjohannes surgicalmanagementofmalignantgliomaintheelderly AT thomeclaudius surgicalmanagementofmalignantgliomaintheelderly AT pinggeradaniel surgicalmanagementofmalignantgliomaintheelderly AT freyschlagchristianf surgicalmanagementofmalignantgliomaintheelderly |