Patterns of care and clinical outcome in assumed glioblastoma without tissue diagnosis: A population-based study of 131 consecutive patients

Abstract

Background Elderly patients with glioblastoma and an accumulation of negative prognostic factors have an extremely short survival. There is no consensus on the clinical management of these patients and many may escape histologically verified diagnosis. The primary aim of this study was to characterize this particular subgroup of patients with radiological glioblastoma diagnosis without histological verification. The secondary aim was to evaluate if oncological therapy was of benefit. Methods Between November 2012 and June 2016, all consecutive patients presenting with a suspected glioblastoma in the western region of Sweden were registered in a population-based study. Of the 378 patients, 131 (35%) met the inclusion criteria of the present study by typical radiological features of glioblastoma without histological verification. Results The clinical characteristics of the 131 patients (72 men, 59 women) were: age � 75 (n = 99, 76%), performance status according to Eastern Cooperative Oncology Group � 2 (n = 93, 71%), significant comorbidity (n = 65, 50%) and multilobular tumors (n = 90, 69%). The overall median survival rate was 3.6 months. A subgroup of 44 patients (34%) received upfront treatment with temozolomide, with an overall radiological response rate of 34% and a median survival of 6.8 months, compared to 2.7 months for those receiving best supportive

Computer-aided diagnosis and prediction in brain disorders

“…As a motivating example, MRI-based prediction of MGMT methylation status could be beneficial to guide treatment decisions. This is supported by findings from a population-based study assessing survival in 131 patients with radiological diagnosis of glioblastoma who did not undergo surgery and thus lacked (histological or molecular) tissue-based verification of the diagnosis [146]. While patients without treatment had extremely poor prognosis with median survival of 3.6 months, those who received upfront temozolomide treatment did significantly better (with median survival of 6.8 months).…”

Risk for morbidity and mortality after neurosurgery in older patients with high grade gliomas – a retrospective population based study

“…This hypothesis is strengthen by the very low incidence rate of surgery during most of the studied years in comparison with reported age specific incidence rates for the largest HGG subgroup, the glioblastomas [ 20 – 22 ]. This study does not have information on patients with a possible glioma that has not undergone surgery and it is known from modern material with an overlapping age group that there may be as much as 35% having radiological features of glioblastoma without histological verification [ 23 ]. Because of this, we would discourage from using our results as an indication of increased incidence of high grade gliomas.…”

Outcome and characteristics of patients with adult grade 4 diffuse gliomas changing sites of treatment

“…Second, the relatively high proportion of tumor biopsies in relation to tumor resection within the Internal Group of patients reflects real world data in a large neuro-oncological institution. While patients with small or superficially located brain tumors might undergo tumor removal in decentral neurosurgical departments—diminishing the number of tumor resections in large comprehensive neuro-oncological centers—stereotactic or robot-assisted biopsies of brain tumors are often limited to large centers, where, moreover, diagnostic procedures and therapy are also offered to very old patients and patients with multiple co-morbidities, who might have rather experienced observation or best supportive care outside these institutions (Lorimer et al 2016 ; Werlenius et al 2020 ).…”