Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age
Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age
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DOI：
10.3171/2011.8.jns102114
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发表时间：
2012-02-01
影响因子：
4.1
通讯作者：
Franz, Kea
中科院分区：
文献类型：
--
作者：
Oszvald, Agi;Gueresir, Erdem;Franz, Kea
对象。本研究的目的是分析年龄是否影响胶质母细胞瘤患者的预后，以及老年胶质母细胞瘤患者是否能忍受与年轻患者相同的积极治疗。从2000-2006年连续361例新诊断的脑胶质母细胞瘤患者的数据被前瞻性地输入数据库，这些患者从最初诊断到死亡接受了定期随访评估。根据肿瘤大小、位置和Karnofsky表现量表评分，患者接受切除（全部、次全或部分）或活检。手术后，所有患者均接受放疗、化疗或联合治疗。年龄大于65岁的患者被定义为老年人（共146例）。234例患者行肿瘤切除术（完全切除26%，次全切除29%，部分切除45%）。127人接受了活检。患者平均年龄61岁，总生存期11.6±12.1个月。老年患者的总生存期（9.1 +/- 11.6个月）明显低于年轻患者（14.9 +/- 16.7个月，p = 0.0001）。在切除或活检之间分层，年龄是活检患者的负面预后因素（4.0 +/- 7.1 vs 7.9 +/- 8.7个月；p = 0.007），但在肿瘤切除术患者中不是（13.0 +/- 8.5 vs 13.3 +/- 14.5个月；p = 0.86）。经肿瘤完全切除的老年患者生存期为17.7 +/- 8.1个月。在这一系列胶质母细胞瘤患者中，年龄是活检患者的预后因素，而不是切除术患者的预后因素。肿瘤的位置和患者的临床状况可能禁止广泛切除，但不应仅因年龄而拒绝患者切除。在老年胶质母细胞瘤患者中，在可行的范围内进行切除，然后进行辅助治疗是必要的。(DOI: 10.3171 / 2011.8.jns102114)
Object. The objective of this study was to analyze whether age influences the outcome of patients with glioblastoma and whether elderly patients with glioblastoma can tolerate the same aggressive treatment as younger patients.Methods. Data from 361 consecutive patients with newly diagnosed cerebral glioblastoma (2000-2006) who underwent regular follow-up evaluation from initial diagnosis until death were prospectively entered into a database. Patients underwent resection (complete, subtotal, or partial) or biopsy, depending on tumor size, location, and Karnofsky Performance Scale score. Following surgery, all patients underwent adjuvant treatment consisting of radiotherapy, chemotherapy, or combined treatment. Patients older than 65 years of age were defined as elderly (146 total).Results. Two hundred thirty-four patients underwent tumor resection (complete 26%, subtotal 29%, and partial 45%). One hundred twenty-seven underwent biopsy. Mean patient age was 61 years, and overall survival was 11.6 +/- 12.1 months. The overall survival of elderly patients (9.1 +/- 11.6 months) was significantly lower than that of younger patients (14.9 +/- 16.7 months; p = 0.0001). Stratifying between resection or biopsy, age was a negative prognostic factor in patients undergoing biopsy (4.0 +/- 7.1 vs 7.9 +/- 8.7 months; p = 0.007), but not in patients undergoing tumor resection (13.0 +/- 8.5 vs 13.3 +/- 14.5 months; p = 0.86). Survival of elderly patients undergoing complete tumor resection was 17.7 +/- 8.1 months.Conclusions. In this series of patients with glioblastoma, age was a prognostic factor in patients undergoing biopsy, but not in patients undergoing resection. Tumor location and patient clinical status may prohibit extensive resection, but resection should not be withheld from patients only on the basis of age. In elderly patients with glioblastoma, undergoing resection to the extent feasible, followed by adjuvant therapies, is warranted. (DOI: 10.3171/2011.8.JNS102114)