The Safety of Surgery in Elderly Patients with Primary and Recurrent Glioblastoma

Randy S. D'Amico, Michael B. Cloney, Adam M. Sonabend, Brad Zacharia, Matthew N. Nazarian, Fabio M. Iwamoto, Michael B. Sisti, Jeffrey N. Bruce, Guy M. McKhann

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background Glioblastoma (GBM) occurs more commonly in elderly patients. However, these patients are often excluded from clinical trials. The absence of solid evidence has resulted in a nihilistic view of GBM in the elderly and a traditionally conservative treatment approach. In particular, the safety of surgical resection for both primary and recurrent GBM is poorly understood in elderly patients. Methods In a retrospective cohort of patients aged ≥65 years, we examined selection for biopsy, surgical resection, and reoperation for recurrent disease. We also analyzed complication rates after initial resection and reoperation for recurrent disease. We identified 319 elderly patients with pathologically proven GBM who underwent a total of 274 craniotomies at our institution between 2000 and 2012. Events were reported according to the methods used in the Glioma Outcomes Project. Results The overall rate of complications after 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 after initial craniotomy and reoperation for GBM in elderly patients. Reoperations were not associated with an increased risk of complications. Low cardiovascular risk, improved functional status, and hemispheric GBM were associated with selection for more aggressive surgical treatment. Younger age and improved functional status were associated with a reduced likelihood of complications. Conclusions We conclude that in select patients, age alone should not preclude the decision to pursue aggressive surgical management.

Original languageEnglish (US)
Pages (from-to)913-919
Number of pages7
JournalWorld neurosurgery
Volume84
Issue number4
DOIs
StatePublished - Oct 2015

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Glioblastoma
Safety
Reoperation
Craniotomy
Glioma
Clinical Trials
Biopsy

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

D'Amico, R. S., Cloney, M. B., Sonabend, A. M., Zacharia, B., Nazarian, M. N., Iwamoto, F. M., ... McKhann, G. M. (2015). The Safety of Surgery in Elderly Patients with Primary and Recurrent Glioblastoma. World neurosurgery, 84(4), 913-919. https://doi.org/10.1016/j.wneu.2015.05.072
D'Amico, Randy S. ; Cloney, Michael B. ; Sonabend, Adam M. ; Zacharia, Brad ; Nazarian, Matthew N. ; Iwamoto, Fabio M. ; Sisti, Michael B. ; Bruce, Jeffrey N. ; McKhann, Guy M. / The Safety of Surgery in Elderly Patients with Primary and Recurrent Glioblastoma. In: World neurosurgery. 2015 ; Vol. 84, No. 4. pp. 913-919.
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abstract = "Background Glioblastoma (GBM) occurs more commonly in elderly patients. However, these patients are often excluded from clinical trials. The absence of solid evidence has resulted in a nihilistic view of GBM in the elderly and a traditionally conservative treatment approach. In particular, the safety of surgical resection for both primary and recurrent GBM is poorly understood in elderly patients. Methods In a retrospective cohort of patients aged ≥65 years, we examined selection for biopsy, surgical resection, and reoperation for recurrent disease. We also analyzed complication rates after initial resection and reoperation for recurrent disease. We identified 319 elderly patients with pathologically proven GBM who underwent a total of 274 craniotomies at our institution between 2000 and 2012. Events were reported according to the methods used in the Glioma Outcomes Project. Results The overall rate of complications after 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 after initial craniotomy and reoperation for GBM in elderly patients. Reoperations were not associated with an increased risk of complications. Low cardiovascular risk, improved functional status, and hemispheric GBM were associated with selection for more aggressive surgical treatment. Younger age and improved functional status were associated with a reduced likelihood of complications. Conclusions We conclude that in select patients, age alone should not preclude the decision to pursue aggressive surgical management.",
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D'Amico, RS, Cloney, MB, Sonabend, AM, Zacharia, B, Nazarian, MN, Iwamoto, FM, Sisti, MB, Bruce, JN & McKhann, GM 2015, 'The Safety of Surgery in Elderly Patients with Primary and Recurrent Glioblastoma', World neurosurgery, vol. 84, no. 4, pp. 913-919. https://doi.org/10.1016/j.wneu.2015.05.072

The Safety of Surgery in Elderly Patients with Primary and Recurrent Glioblastoma. / D'Amico, Randy S.; Cloney, Michael B.; Sonabend, Adam M.; Zacharia, Brad; Nazarian, Matthew N.; Iwamoto, Fabio M.; Sisti, Michael B.; Bruce, Jeffrey N.; McKhann, Guy M.

In: World neurosurgery, Vol. 84, No. 4, 10.2015, p. 913-919.

Research output: Contribution to journalArticle

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T1 - The Safety of Surgery in Elderly Patients with Primary and Recurrent Glioblastoma

AU - D'Amico, Randy S.

AU - Cloney, Michael B.

AU - Sonabend, Adam M.

AU - Zacharia, Brad

AU - Nazarian, Matthew N.

AU - Iwamoto, Fabio M.

AU - Sisti, Michael B.

AU - Bruce, Jeffrey N.

AU - McKhann, Guy M.

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N2 - Background Glioblastoma (GBM) occurs more commonly in elderly patients. However, these patients are often excluded from clinical trials. The absence of solid evidence has resulted in a nihilistic view of GBM in the elderly and a traditionally conservative treatment approach. In particular, the safety of surgical resection for both primary and recurrent GBM is poorly understood in elderly patients. Methods In a retrospective cohort of patients aged ≥65 years, we examined selection for biopsy, surgical resection, and reoperation for recurrent disease. We also analyzed complication rates after initial resection and reoperation for recurrent disease. We identified 319 elderly patients with pathologically proven GBM who underwent a total of 274 craniotomies at our institution between 2000 and 2012. Events were reported according to the methods used in the Glioma Outcomes Project. Results The overall rate of complications after 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 after initial craniotomy and reoperation for GBM in elderly patients. Reoperations were not associated with an increased risk of complications. Low cardiovascular risk, improved functional status, and hemispheric GBM were associated with selection for more aggressive surgical treatment. Younger age and improved functional status were associated with a reduced likelihood of complications. Conclusions We conclude that in select patients, age alone should not preclude the decision to pursue aggressive surgical management.

AB - Background Glioblastoma (GBM) occurs more commonly in elderly patients. However, these patients are often excluded from clinical trials. The absence of solid evidence has resulted in a nihilistic view of GBM in the elderly and a traditionally conservative treatment approach. In particular, the safety of surgical resection for both primary and recurrent GBM is poorly understood in elderly patients. Methods In a retrospective cohort of patients aged ≥65 years, we examined selection for biopsy, surgical resection, and reoperation for recurrent disease. We also analyzed complication rates after initial resection and reoperation for recurrent disease. We identified 319 elderly patients with pathologically proven GBM who underwent a total of 274 craniotomies at our institution between 2000 and 2012. Events were reported according to the methods used in the Glioma Outcomes Project. Results The overall rate of complications after 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 after initial craniotomy and reoperation for GBM in elderly patients. Reoperations were not associated with an increased risk of complications. Low cardiovascular risk, improved functional status, and hemispheric GBM were associated with selection for more aggressive surgical treatment. Younger age and improved functional status were associated with a reduced likelihood of complications. Conclusions We conclude that in select patients, age alone should not preclude the decision to pursue aggressive surgical management.

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