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

Cunha, Marcelo Lemos Vieira da; Esmeraldo, Augusto Cesar Santos; Leonardo, Augusto Wendling Henriques; Santos, Marcos Antônio Martins dos; Medeiros, Roger Thomaz Rotta; Botelho, Ricardo Vieira

doi:10.1590/1806-9282.65.12.1433

Cited by 4 publications

(3 citation statements)

References 1 publication

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“…Still, caution is advised in interpreting this finding owing to the high complication rate. 32 Despite these concerns, our retrospective data showed that decreased performance status or serious complications such as hemiparesis, aphasia, and declined mentality did not increase according to the EOR. This is evident because, in addition to GTR, a lobectomy was performed only in the noneloquent area in the nondominant lobe.…”

Section: Discussionmentioning

confidence: 64%

Patterns of recurrence according to the extent of resection in patients with IDH–wild-type glioblastoma: a retrospective study

Yoo

Yoon

Kim

et al. 2022

Journal of Neurosurgery

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OBJECTIVE In glioblastoma (GBM) patients, controlling the microenvironment around the tumor using various treatment modalities, including surgical intervention, is essential in determining the outcome of treatment. This study was conducted to elucidate whether recurrence patterns differ according to the extent of resection (EOR) and whether this difference affects prognosis. METHODS This single-center study included 358 eligible patients with histologically confirmed isocitrate dehydrogenase (IDH)–wild-type GBM from November 1, 2005, to December 31, 2018. Patients were assigned to one of three separate groups according to EOR: supratotal resection (SupTR), gross-total resection (GTR), and subtotal resection (STR) groups. The patterns of recurrence were classified as local, marginal, and distant based on the range of radiation. The relationship between EOR and recurrence pattern was statistically analyzed. RESULTS Observed tumor recurrence rates for each group were as follows: SupTR group, 63.4%; GTR group, 75.3%; and STR group, 80.5% (p = 0.072). Statistically significant differences in patterns of recurrences among groups were observed with respect to local recurrence (SupTR, 57.7%; GTR, 76.0%; STR, 82.8%; p = 0.036) and distant recurrence (SupTR, 50.0%; GTR, 30.1%; STR, 23.2%; p = 0.028). Marginal recurrence showed no statistical difference between groups. Both overall survival and progression-free survival were significantly increased in the SupTR group compared with the STR and GTR groups (p < 0.0001). CONCLUSIONS In this study, the authors investigated the association between EOR and patterns of recurrence in patients with IDH–wild-type GBM. The findings not only show that recurrence patterns differ according to EOR but also provide clinical evidence supporting the hypothesized mechanism by which distant recurrence occurs.

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Section: Discussionmentioning

confidence: 64%

Patterns of recurrence according to the extent of resection in patients with IDH–wild-type glioblastoma: a retrospective study

Yoo

Yoon

Kim

et al. 2022

Journal of Neurosurgery

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“…Median OS was significantly longer in patients with GTR (10.8 months) compared with partial resection (PR) (8.1 months) or biopsy (3.0 months). A systematic review between 2005 and 2018 demonstrated that total resection was associated with longer postoperative OS (13.13 months) when compared with PR (7.52 months) or biopsy (2.56 months) in seven clinical studies ( 28 ). In an Italian cohort of 178 elderly patients, CR was seen in 8 patients (4.5%), GTR in 63 (35.4%), subtotal resection (STR) in 46 (25.8%), PR in 16 (9.0%) and biopsy in 45 (25.3%).…”

Section: Surgical Resectionmentioning

confidence: 99%

Optimal managements of elderly patients with glioblastoma

Arakawa

Mineharu

Uto

et al. 2022

Japanese Journal of Clinical Oncology

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Optimizing the management of elderly patients with glioblastoma is an ongoing task in neuro-oncology. The number of patients with this tumor type is gradually increasing with the aging of the population. Although available data and practice recommendations remain limited, the current strategy is maximal safe surgical resection followed by radiotherapy in combination with temozolomide. However, survival is significantly worse than that in the younger population. Surgical resection provides survival benefit in patients with good performance status. Hypofractionated radiotherapy decreases toxicities while maintaining therapeutic efficacy, thus improving treatment adherence and subsequently leading to better quality of life. The intensity of these treatments should be balanced with patient-specific factors and consideration of quality of life. This review discusses the current optimal management in terms of efficacy and safety, as well as future perspectives.

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“…It is important to highlight that the EOR was the most robust influencing factor in the algorithm hierarchy, while age appeared at the third node of the CART algorithm, thus strengthening the role of surgery also in EGBM and performing patients (who have a high preoperative KPS score), when surgical planning allowed us to preoperatively estimate an EOR > 80%. 6,17,42 In a previous investigation, Flanigan et al elaborated a risk prognostic score in EGBM patients based on variables identified using the multivariate stepwise analysis (age, EOR, preoperative weakness, tumor size, and CCI). 1 A point designation was then given to each factor and points were totaled for each patient, considering only the presence of the variables and ruling out their interactions.…”

Section: Cart Analysismentioning

confidence: 99%

Is age an additional factor in the treatment of elderly patients with glioblastoma? A new stratification model: an Italian Multicenter Study

Ius

Teresa

Altieri

et al. 2020

Neurosurgical Focus

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OBJECTIVEApproximately half of glioblastoma (GBM) cases develop in geriatric patients, and this trend is destined to increase with the aging of the population. The optimal strategy for management of GBM in elderly patients remains controversial. The aim of this study was to assess the role of surgery in the elderly (≥ 65 years old) based on clinical, molecular, and imaging data routinely available in neurosurgical departments and to assess a prognostic survival score that could be helpful in stratifying the prognosis for elderly GBM patients.METHODSClinical, radiological, surgical, and molecular data were retrospectively analyzed in 322 patients with GBM from 9 neurosurgical centers. Univariate and multivariate analyses were performed to identify predictors of survival. A random forest approach (classification and regression tree [CART] analysis) was utilized to create the prognostic survival score.RESULTSSurvival analysis showed that overall survival (OS) was influenced by age as a continuous variable (p = 0.018), MGMT (p = 0.012), extent of resection (EOR; p = 0.002), and preoperative tumor growth pattern (evaluated with the preoperative T1/T2 MRI index; p = 0.002). CART analysis was used to create the prognostic survival score, forming six different survival groups on the basis of tumor volumetric, surgical, and molecular features. Terminal nodes with similar hazard ratios were grouped together to form a final diagram composed of five classes with different OSs (p < 0.0001). EOR was the most robust influencing factor in the algorithm hierarchy, while age appeared at the third node of the CART algorithm. The ability of the prognostic survival score to predict death was determined by a Harrell’s c-index of 0.75 (95% CI 0.76–0.81).CONCLUSIONSThe CART algorithm provided a promising, thorough, and new clinical prognostic survival score for elderly surgical patients with GBM. The prognostic survival score can be useful to stratify survival risk in elderly GBM patients with different surgical, radiological, and molecular profiles, thus assisting physicians in daily clinical management. The preliminary model, however, requires validation with future prospective investigations. Practical recommendations for clinicians/surgeons would strengthen the quality of the study; e.g., surgery can be considered as a first therapeutic option in the workflow of elderly patients with GBM, especially when the preoperative estimated EOR is greater than 80%.

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

Cited by 4 publications

References 1 publication

Patterns of recurrence according to the extent of resection in patients with IDH–wild-type glioblastoma: a retrospective study

Patterns of recurrence according to the extent of resection in patients with IDH–wild-type glioblastoma: a retrospective study

Optimal managements of elderly patients with glioblastoma

Is age an additional factor in the treatment of elderly patients with glioblastoma? A new stratification model: an Italian Multicenter Study

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