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  • 5-ALA Fluorescence, Neuromonitoring and Intraoperative Image Guidance for Surgical Treatment of Glioblastoma in Elderly Population: State of Art or Overtreatment?

    Final Number:

    Giuseppe Barbagallo MD; Francesco Certo MD; Giuseppe Raudino MD; Massimiliano Maione MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: The role of surgery in management of glioblastoma patients aging more than 65 years is controversial. This study describes our institutional experience with surgical treatment of glioblastoma in elderly population, highlighting the impact of 5-aminolevuinic acid (5-ALA) guidance and supportive intraoperative tools (neuromonitoring, intra-operative CT) on surgical and clinical results.

    Methods: 52 patients (29 males, 23 females, mean age 72, range 65-83) suffering from glioblastoma and aging over 65 year old have been included in this study. 31 patients (Group A) underwent 5-ALA fluorescence guided surgical resection; intraoperative CT scan and electrophysiological mapping of eloquent areas have been also used in selected cases. An historical cohort of 21 patients (Group B) surgically treated before the introduction of 5-ALA at our Institution, with conventional microneurosurgery and neuronavigation, has been used as control group. Pre- and post-operative Karnofsky performance score (KPS), Temozolomyde cycles, Radiotherapy doses and extent of tumor resection (EOTR) were measured in both groups.

    Results: Mean KPS varied from 69.67 to 70.69 and from 58 to 63, mean temozolomyde cycles were 7.03 and 6, mean radiotherapy doses 52.51 and 57.0 in Group A and B respectively. Gross total resection has been achieved in 30/31 and in 19/21 patients in Group A and B respectively. Overall survival (OS) was 13.87 and 11 months respectively, whereas progression free survival (PFS) was 9.13 and 7.38 months respectively.

    Conclusions: Aggressive surgical treatment, helped by 5-ALA fluorescence and application of supportive technologies such as i-CT or neuromonitoring, may guarantee an extended but still safe resection of glioblastoma in elderly population. The maintenance of a good performance status in elderly population is essential to allow the adequate administration of adjuvant therapies after surgery and to improve survival parameters.

    Patient Care: Our research introduces an aggressive but still safe management of glioblastoma in elderly population.

    Learning Objectives: By the conclusion of this session, participants should be able to: - discuss the best management of elderly patients suffering from glioblastoma, in the new era of technology assisted surgery. - analyze the safety and the effectiveness of 5-ALA fluorescence assisted surgery in elderly patients suffering from glioblastoma. - investigate the impact of aggressive but still safe surgery on clinical outcome of elderly patients suffering from glioblastoma.


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