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.
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