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  • The Safety of Surgery in Elderly Patients with Primary and Recurrent Glioblastoma

    Final Number:

    Michael Brendan Cloney BA; Randy D'Amico MD; Adam M. Sonabend MD; Brad E. Zacharia MD, MS; Matthew Nazarian BS; Michael B. Sisti MD; Jeffrey N. Bruce MD; Guy M. McKhann

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Elderly patients with glioblastoma (GBM) are frequently excluded from clinical trials despite a higher incidence compared to younger patients. As a result, poorly defined treatment practices may result in empiric conservative management in elderly patients. In particular, the safety of surgical resection for both primary and recurrent GBM is poorly understood in elderly patients.

    Methods: We investigated adverse postoperative events in a retrospective cohort of elderly patients age 65 years or older who underwent craniotomy for unilateral, unifocal, lobar GBM at our institution from 2000 to 2012. Additionally, we investigated adverse postoperative events following reoperation for recurrent disease in a subset of patients. Events were reported according to the rigorous methods originally employed in the Glioma Outcomes Project.

    Results: We identified 243 elderly patients who underwent a total of 274 craniotomies. The overall rate of complications following resection was 21.9%, with a rate of neurological complications of 7.7%. The rates of neurological, regional and systemic complications were not significantly different following initial craniotomy and reoperation for GBM in elderly patients. Lower cardiovascular risk was associated with likelihood of reoperation on multivariate analysis.

    Conclusions: Complication rates are similar following initial craniotomy and reoperation in select elderly patients with GBM and comparable to rigorously reported rates in non-elderly patients undergoing craniotomy for primary or recurrent GBM. Age should not preclude aggressive surgical management of primary or recurrent GBM in select elderly patients.

    Patient Care: Elderly patients account for a substantial and unique portion of the GBM population for which there is a relative lack of clinical evidence. While investigations have explored the role of surgery for elderly patients with GBM, the safety and efficacy of surgery in this population remains controversial and warrants further examination [4-8]. Furthermore, while reoperation for recurrent disease has been examined primarily in non-elderly patients [9, 10], the safety and efficacy of repeat craniotomy in elderly patients remains poorly characterized despite evidence supporting prognostic benefits with reoperation [8, 11].

    Learning Objectives: Improve clinical decision-making with respect to surgical therapy for elderly patients with glioblastoma.

    References: 4. Oszvald, A., et al., Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age. Journal of neurosurgery, 2012. 116(2): p. 357-364. 5. Kelly, P.J. and C. Hunt, The limited value of cytoreductive surgery in elderly patients with malignant gliomas. Neurosurgery, 1994. 34(1): p. 62-6- discussion 66-7. 6. Iwamoto, F.M., et al., Glioblastoma in the elderly: the Memorial Sloan-Kettering Cancer Center Experience (1997-2007). Cancer, 2009. 115(16): p. 3758-3766. 7. Tanaka, S., et al., Presentation, management, and outcome of newly diagnosed glioblastoma in elderly patients. Journal of neurosurgery, 2013. 118(4): p. 786-798. 8. Stark, A.M., et al., Glioblastoma--the consequences of advanced patient age on treatment and survival. Neurosurg Rev, 2007. 30(1): p. 56-61; discussion 61-2. 9. Chaichana, K.L., et al., Multiple resections for patients with glioblastoma: prolonging survival. Journal of neurosurgery, 2012. 10. Hoover, J.M., et al., Surgical outcomes in recurrent glioma. Journal of neurosurgery, 2013. 11. Barbagallo, G.M.V., M.D. Jenkinson, and A.R. Brodbelt, ‘Recurrent’ glioblastoma multiforme, when should we reoperate? British journal of neurosurgery, 2008. 22(3): p. 452-455.

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