Elderly patients with glioblastoma: the impact of surgical resection extent on survival

Abstract

The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient. The impact of the neurosurgery in elderly patients with glioblastoma multiforme (GBM) is still unclear. The objective of this systematic review was to evaluate the overall survival of patients over 65 years old submitted to GBM surgical treatment and analyze the rates of postoperative complications in this population. A search on the Medline, Cochrane e Google Scholar electronic databases between January 2005 and April 2018 identified seven studies that evaluated the neurosurgical treatment of patients older than 65 years with GBM. Surgical procedures included complete or partial resection or tumor biopsy. In elderly GBM patients, total surgical resection of the tumor was associated with longer overall postoperative survival when compared with the partial resection or biopsy. Based on this study, neurosurgery is recommended to increase the overall survival of elderly patients with GBM and a good overall preoperative condition. The high rate of complications in this population should be taken into consideration for the surgical decision. The details of the methodology of this guideline are set out in Annex I.

A Novel Comprehensive Clinical Stratification Model to Refine Prognosis of Glioblastoma Patients Undergoing Surgical Resection

“…Elderly age negatively affected the prognosis only in cases of limited resection, supporting the role of surgery in fit older patients when a safe and large resection can be planned [42][43][44].…”

“…Age, performance status, extent of surgical resection and MGMT methylation status are well known prognostic factors for GBM patients [4,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][39][40][41][42][43][44]. Nevertheless, the high degree of clinical/molecular heterogeneity found among GBM patients do not generally allow us to correctly classify GBM patients with the use of a single predictor or a few predictors.…”

Homeobox B2 is a potential prognostic biomarker of glioblastoma

“…Currently, the standard treatment methods are surgery, chemotherapy, and radiation therapy 2 . A recent study found that surgical resection extent in elderly patients with glioblastoma has an impact on survival 3 . In recent years, researchers have been working to explore the molecular mechanisms of gliomas, discovering telomerase reverse transcriptase and many other molecules 4, 5 .…”

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

“…Recent studies have shown that, in addition to conventional prognostic factors, the molecular profile of tumors can be used to select from these treatment alternatives. [3][4][5][6][7][8][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Microsurgery's place within this framework remains unclear. 6,[18][19][20][21][22] Even though gross total resection (GTR) has been proven to increase OS, little data are available concerning the risks and benefits of resections in older adults.…”

“…[3][4][5][6][7][8][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Microsurgery's place within this framework remains unclear. 6,[18][19][20][21][22] Even though gross total resection (GTR) has been proven to increase OS, little data are available concerning the risks and benefits of resections in older adults. 8,[11][12][13][14][15][16][17][18] This retrospective study by 2 neuro-oncology centers has been performed to assess the prognostic profile, clinical outcome, treatment-associated morbidity, and treatment burden of elderly patients with newly diagnosed GBM, who were found eligible for elective tumor resection as part of contemporary management.…”