Resection of recurrent glioblastoma multiforme in elderly patients: a pseudo-randomized analysis revealed clinical benefit
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Elderly patients constitute an expanding part of our society. Due to a continuously increasing life expectancy, an optimal quality of life is expected even into advanced age. Glioblastoma (GBM) is more common in older patients, but they are still often withheld from efficient treatment due to worry of worse tolerance and have a significantly worse prognosis compared to younger patients. Our retrospective observational study aimed to investigate the therapeutic benefit from a second resection in recurrent glioblastoma of elderly patients.
Materials and methods
We included a cohort of 39 elderly patients (> 65 years) with a second resection as treatment option in the case of a tumor recurrence. A causal inference model was built by multiple non- and semiparametric models, which was used to identify matched patients from our elderly GBM database which comprises 538 patients. The matched cohorts were analyzed by a Cox-regression model adjusted by time-dependent covariates.
The Cox-regression analysis showed a significant survival benefit (Hazard Ratio: 0.6, 95% CI 0.36–0.9, p-value = 0.0427) for the re-resected group (18.0 months, 95% CI 13.97–23.2 months) compared to the group without re-resection (10.1 months, 95% CI 8.09–20.9 months). No differences in the co-morbidities or hemato-oncological side effects during chemotherapy could be detected. Anesthetic- and surgical complications were rare and comparable to the complication rate of patients undergoing the first-line resection.
Taken together, in elderly patients, re-resection is an acceptable treatment option in the recurrent state of a glioblastoma. The individual evaluation of the patients′ medical status as well as the chances of withstanding general anesthesia needs to be done in close interdisciplinary consultation. If these requirements are met, elderly patients benefit from a re-resection.
KeywordsRecurrent glioblastoma multiforme Elderly patients Re-Resection
This study was funded by the German Cancer Society (SGTII) and the Müller-Fahnenberg Stiftung.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Stupp R, Taillibert S, Kanner A et al (2017) Effect of tumor-treating fields plus maintenance temozolomide vs maintenance temozolomide alone on survival in patients with glioblastoma: a randomized clinical trial. JAMA 318(23):2306–2316. https://doi.org/10.1001/jama.2017.18718 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Sughrue ME, Sheean T, Bonney PA, Maurer A J & Teo C. (2015) Aggressive repeat surgery for focally recurrent primary glioblastoma: outcomes and theoretical framework. Neurosurg Focus FOC 38(3):E11. Accessed Oct 29, 2018. https://thejns.org/view/journals/neurosurg-focus/38/3/article-pE11.xml
- 19.Colson KE, Rudolph KE, Zimmerman SC, et al (2016) Optimizing matching and analysis combinations for estimating causal effects. Sci Rep 6:23222. https://doi.org/10.1038/srep23222
- 20.Goldman DA, Hovinga K, Reiner AS, Esquenazi Y, Tabar V, Panageas KS (2018) The relationship between repeat resection and overall survival in patients with glioblastoma: a time-dependent analysis. J Neurosurg 129(5):1231–1239. https://doi.org/10.3171/2017.6.JNS17393 CrossRefPubMedPubMedCentralGoogle Scholar