Introduction: Old age has been pointed as one of the most important negative outcome predictors for patients with malignant gliomas (MG) and extent of resection has been proved to be an important positive prognostic factor for overall survival. Use of 5-amminolevulinic acid (5-ALA) provides highly specific intraoperative tumour identification enabling the surgeon a more reliable gross total tumour removal.
We aimed to evaluate the prognostic value of age in patients with MG who underwent fluorescence-guided surgery with 5-ALA (FGS).
Methods: Retrospective study of all consecutive MG patients submitted to FGS from December 2008 to December 2013. The aim of all surgeries was gross total resection of the MRI, T1/gadolinium identifiable tumour. Age, Karnofsky Performance Status prior to surgeries, tumour location, histology, number of gross total resection surgeries and extent of resection and volume of residual tumour were accessed. The population was divided into 3 groups according with age at diagnosis: <45, 45-65, >65 years old (yrs). Average overall survival was compared among the three populations, using univariate and multivariate analysis. All patients were submitted to the same radiotherapy and temozolomide standard protocol. Statistical analysis was calculated with Prism6 v.6.0 for Mac OS-X.
Results: A total of 66 5-ALA-GS were performed on 51 patients, with a median follow-up of 38.3±17 months. Average age of the population was 54.5±12.8 yrs (min.26-max.79). Age distribution was as follows: 21.3% with <45yrs; 55.3% between 45-65yrs; 23.4% >65yrs. Median survival was 18, 22 and 22 months, respectively. The median survival was 22 ± 15 months (70.7% patients alive at 12 months and 38.1% at 24). No other statistical significant differences were found between groups regarding the variables studied.
No statistically significant correlation between age and survival time was found (Mantel-Cox p>0.50).
Conclusions: Aggressive surgical attitude for the treatment of MG with 5-ALA, allowed median survival of 22 months regardless of patient age at diagnosis.
Patient Care: Hopefully it will reinforce evidence to encourage a more
aggressive surgical attitude when facing a malignant glioma in old patients.
Learning Objectives: Access the impact of age when gross total removal of malignant glioma is intended, in patients that underwent fluorescence-guided surgery.