Surgical strategies for older patients with glioblastoma

Tanyeri Barak, Shaurey Vetsa, Arushii Nadar, Lan Jin, Trisha P. Gupte, Elena I. Fomchenko, Danielle F. Miyagishima, Kanat Yalcin, Sagar Vasandani, Evan Gorelick, Amy Y. Zhao, Joseph Antonios, Brianna Carusillo Theriault, Nathan Lifton, Neelan Marianayagam, Bulent Omay, Zeynep Erson Omay, Anita Huttner, Declan McGuone, Nicholas A. BlondinZachary Corbin, Robert K. Fulbright, Jennifer Moliterno*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: While adjuvant treatment regimens have been modified for older patients with glioblastoma (GBM), surgical strategies have not been tailored. Methods: Clinical data of 48 consecutive patients aged 70 years or older, who underwent surgical resection for GBM with intraoperative ultrasonography (IoUS) alone or combination with intraoperative MRI (IoMRI) at Yale New Haven Hospital were retrospectively reviewed. Variables were analyzed, and comparative analyses were performed. Results: The addition of IoMRI was not superior to IoUS alone in terms of overall survival (OS) (P = 0.306), Karnofsky Performance Score (KPS) at postoperative 6 weeks (P = 0.704) or extent of resection (P = 0.263). Length of surgery (LOSx), however, was significantly longer (P = 0.0002) in the IoMRI group. LOSx (P = 0.015) and hospital stay (P = 0.025) were predictors of postoperative complications. Increased EOR (GTR or NTR) (P = 0.030), postoperative adjuvant treatment (P < 0.0001) and postoperative complications (P = 0.006) were predictive for OS. Patients with relatively lower preoperative KPS scores (<70) showed significant improvement at postoperative 6 weeks (P<0.0001). Patients with complications (P = 0.038) were more likely to have lower KPS at postoperative 6 weeks. Conclusions: Aggressive management with surgical resection should be considered in older patients with GBM, even those with relatively poor KPS. The use of ioMRI in this population does not appear to confer any measurable benefit over ioUS in experienced hands, but prolongs the length of surgery significantly, which is a preventable prognostic factor for impeding care.

Original languageEnglish
JournalJournal of Neuro-Oncology
DOIs
Publication statusAccepted/In press - 2021
Externally publishedYes

Bibliographical note

Funding Information:
We are grateful to the patients who contributed to this study. This study was supported by the Gregory M. Kiez and Mehmet Kutman Foundation. This study was also supported by the Connecticut Brain Tumor Alliance.

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Keywords

  • Glioblastoma
  • Intraoperative imaging
  • Neuronavigation
  • Surgical strategies

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