Albrecht Carolin, Baumgart Lea, Schroeder Axel, Wiestler Benedikt, Meyer Bernhard, Krieg Sandro M, Ille Sebastian
Department of Neurosurgery, Technical University of Munich, Germany.
School of Medicine, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.
Brain Spine. 2024 Jan 3;4:102742. doi: 10.1016/j.bas.2023.102742. eCollection 2024.
Many patients with high-grade gliomas (HGG) are of older age.
We hypothesize that pre- and intraoperative mapping and monitoring preserve functional status in elderly patients while gross total resection (GTR) is the aim, resulting in overall survival (OS) rates comparable to the general population with HGG.
We subdivided a prospective cohort of 168 patients above 65 years with eloquent high-grade gliomas into four groups ([years/cases] 1: 65-69/58; 2: 70-74/47; 3: 75-79/43; 4: >79/20). All patients underwent preoperative noninvasive mapping, which was also used for decision-making, intraoperative neuromonitoring in 138 cases, direct cortical and/or subcortical motor mapping in 66 and 50 cases, and awake language mapping in 11 cases.
GTR and subtotal resection (STR) could be achieved in 65% and 28%, respectively. Stereotactic biopsy was performed in 8% of cases. Postoperatively, we found transient and permanent functional deficits in 13% and 11% of cases. Postoperative Karnofsky Performance Scale (KPS) did not differ between subgroups. Patients with long-term follow-up (51%) had a progression-free survival of 5.5 (1-47) months and an overall survival of 10.5 (0-86) months.
The interdisciplinary glioma treatment in the elderly is less age-dependent but must be adjusted to the functional status. Function-guided surgical resections could be performed as usual, with maximal tumor resection being the primary goal. However, less network capacity in the elderly to compensate for deficits might cause higher rates of permanent deficits in this group of patients with more fast-growing malignant gliomas.
许多高级别胶质瘤（HGG）患者年龄较大。
我们假设，在以实现大体全切除（GTR）为目标的情况下，术前和术中的图谱绘制及监测可维持老年患者的功能状态，从而使总生存率（OS）与患有HGG的普通人群相当。
我们将一个由168例65岁以上患有明确高级别胶质瘤的患者组成的前瞻性队列分为四组（[年龄/病例数] 1组：65 - 69岁/58例；2组：70 - 74岁/47例；3组：75 - 79岁/43例；4组：>79岁/20例）。所有患者均接受了术前无创图谱绘制，该图谱也用于决策，138例患者进行了术中神经监测，66例和50例分别进行了直接皮质和/或皮质下运动图谱绘制，11例进行了清醒语言图谱绘制。
分别有65%和28%的患者实现了GTR和次全切除（STR）。8%的病例进行了立体定向活检。术后，我们在13%和11%的病例中发现了短暂性和永久性功能缺陷。各亚组之间术后卡氏功能状态评分（KPS）无差异。接受长期随访的患者（51%）无进展生存期为5.5（1 - 47）个月，总生存期为10.5（0 - 8）个月。
老年患者的多学科胶质瘤治疗对年龄的依赖性较小，但必须根据功能状态进行调整。功能引导下的手术切除可照常进行，以最大程度切除肿瘤为主要目标。然而，老年患者补偿缺陷的能力较弱，这可能导致在这组生长较快的恶性胶质瘤患者中永久性缺陷的发生率更高。
