Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.
Faculty of Medicine, University of Freiburg, Freiburg, Germany.
J Neurooncol. 2018 Nov;140(2):385-391. doi: 10.1007/s11060-018-2964-8. Epub 2018 Aug 3.
Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults with peak incidence in patients older than 65 years. These patients are mostly underrepresented in clinical trials and often undertreated due to concomitant diseases. Recently, different therapeutic approaches for elderly patients with GBM were discussed. To date, there is no defined standard treatment. The aim of the present study is to evaluate the functional and oncological outcome in surgical treatment of elderly patients.
A total of 342 elderly patients aged ≥ 65 years were retrospectively analyzed in our neurosurgical center. Surgical therapy, adjuvant treatment, overall survival (OS) and functional outcome using Karnofsky performance scale (KPS) and Neurological assessment of neuro-oncology-score were analyzed.
The median age at GBM diagnosis was 73.4 (IQR 9.28) years. Median overall survival was 7.5 (CI 95% 6.0-9.1) months and median preoperative or postoperative KPS was 80 (IQR 20). Surgical resection was performed in 216 (63.2%) patients, in 125 patients (36.5%) patients a stereotactic biopsy was performed. The median OS was significantly higher in patients with gross total resection (GTR) compared to partial resection and biopsy (10.8 months; CI 95% 9.5-12.3). Patients with combined radio- and chemo-therapy (RCT) showed significant longer OS, particularly MGMT-negative GBM. Higher preoperative KPS was found to be associated with improved overall survival.
GTR and adjuvant combined RCT provides benefits for overall survival in elderly patients. Therapy decision should be made in regard to preoperative functional status instead of biological age.
多形性胶质母细胞瘤（GBM）是成年人中最常见的恶性原发性脑肿瘤，发病高峰在 65 岁以上的患者。这些患者在临床试验中代表性不足，并且由于合并症常得不到充分治疗。最近，人们讨论了针对老年 GBM 患者的不同治疗方法。迄今为止，尚无明确的标准治疗方法。本研究旨在评估老年患者手术治疗的功能和肿瘤学结果。
在我们的神经外科中心，回顾性分析了 342 名年龄≥65 岁的老年患者。分析了手术治疗、辅助治疗、总生存期（OS）和功能结果（使用 Karnofsky 表现量表（KPS）和神经肿瘤学评分的神经学评估）。
GBM 诊断时的中位年龄为 73.4（IQR9.28）岁。中位总生存期为 7.5（CI95%6.0-9.1）个月，术前或术后 KPS 中位数为 80（IQR20）。216 例（63.2%）患者行手术切除，125 例（36.5%）患者行立体定向活检。与部分切除和活检相比，大体全切除（GTR）患者的中位 OS 显著更高（10.8 个月；CI95%9.5-12.3）。联合放化疗（RCT）的患者 OS 显著延长，尤其是 MGMT 阴性 GBM。术前 KPS 较高与总生存改善相关。
GTR 和辅助联合 RCT 可提高老年患者的总生存率。治疗决策应根据术前功能状态而不是生物学年龄做出。
