Introduction: While constituting a substantial portion of patients with glioblastoma (GBM), elderly patients have a worse prognosis and are presumed to have an increased risk of surgical complications. This has translated into exclusion of this population from most clinical trials, and a scarcity of safety and efficacy data on these patients. Specifically, the safety of craniotomy for resection of GBM remains poorly understood, possibly leading to empiric conservative management.
Methods: We analyzed a retrospective series of patients >65 years old who underwent a craniotomy for resection of GBM at our institution between years 2000 and 2012. Only patients with unilateral, unifocal, lobar GBM were included. Complications included new neurological deficits, seizure disorders, thrombotic/embolic events, intracranial hemorrhage, meningitis, wound infections, and cardiopulmonary events requiring medical intervention.
Results: We identified 226 patients, including 200 patients that underwent a single craniotomy, 23 patients that underwent two resections, and three patients underwent three resections. Overall complication rate was 13.3%, including 1% for postoperative neurological deficits, 2% for intracranial hemorrhage, and 8.2% for medical complications including of pulmonary embolism/deep venous thrombosis (0.8%), pneumonia (5.1%), and cardiac ischemia (0.8%). The perioperative complication rate following a first craniotomy was 13.3%, which was not significantly different from that seen following second or third craniotomies for disease recurrence (13.6%, chi-squared >0.05). The average length of hospitalization was 4 days (range 2-63 days), which was not different from craniotomies for recurrence. 3 patients died following their first craniotomy, and none died following reoperations. We applied the Park Scale for predicting postoperative survival for recurrent GBM, and showed that it remains predictive of overall survival for elderly patients with recurrent GBM.
Conclusions: Surgical resection is tolerable in elderly patients with GBM, including recurrent disease. These results might contribute to the risk-benefit discussion regarding surgical management of GBM for this important population.
Patient Care: Recurrence after surgical resection of GBM is inevitable, making it critical that there be a thorough understanding of the therapeutic options for recurrent disease. Patients over age 65 account for approximately half of all primary GBM patients. By elaborating on the safety of reoperation for recurrent GBM in elderly patients, we hope to better define the therapeutic options available at the time of recurrence for a significant portion of GBM patients.
Learning Objectives: By the conclusion of this session, participants should be able to 1) appreciate the importance of understanding surgical intervention for elderly GBM patients, 2) understand the safety of surgical resection for GBM in elderly patients, and 3) consider the possibility of surgical resection for recurrent GBM in elderly patients.