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. 2021 Dec;155(3):255-264.
doi: 10.1007/s11060-021-03862-z. Epub 2021 Oct 9.

Surgical strategies for older patients with glioblastoma

Tanyeri Barak  1   2   3 , Shaurey Vetsa  1   2 , Arushii Nadar  1   2 , Lan Jin  1   2   4   5 , Trisha P Gupte  1   2 , Elena I Fomchenko  1   2 , Danielle F Miyagishima  1   2 , Kanat Yalcin  1 , Sagar Vasandani  1   2 , Evan Gorelick  1   2 , Amy Y Zhao  1   2 , Joseph Antonios  1   2 , Brianna Carusillo Theriault  1   2 , Nathan Lifton  1   2 , Neelan Marianayagam  1   2 , Bulent Omay  1   2 , Zeynep Erson Omay  1   2 , Anita Huttner  2   6 , Declan McGuone  2   6 , Nicholas A Blondin  2   7 , Zachary Corbin  2   7 , Robert K Fulbright  2   8 , Jennifer Moliterno  9   10
Affiliations

Surgical strategies for older patients with glioblastoma

Tanyeri Barak et al. J Neurooncol. 2021 Dec.

Erratum in

  • Correction to: Surgical strategies for older patients with glioblastoma.
    Barak T, Vetsa S, Nadar A, Jin L, Gupte TP, Fomchenko EI, Miyagishima DF, Yalcin K, Vasandani S, Gorelick E, Zhao AY, Antonios J, Theriault BC, Lifton N, Marianayagam N, Omay B, Omay ZE, Huttner A, McGuone D, Blondin NA, Corbin Z, Fulbright RK, Moliterno J. Barak T, et al. J Neurooncol. 2021 Dec;155(3):265. doi: 10.1007/s11060-021-03888-3. J Neurooncol. 2021. PMID: 34813021 Free PMC article. No abstract available.

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.

Keywords: Glioblastoma; Intraoperative imaging; Neuronavigation; Surgical strategies.

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Figures

Fig. 1
Fig. 1
Patients with pre-operative KPS score <70 demonstrated significant improvement 6-weeks after surgical resection. Paired parallel axis dot plot showing significant functional improvement for patients with pre-op KPS score <70 following the surgical resection (p<0.0001) (A) ,while no significant changes were observed in pre-op KPS score ≥ 70 group (B). Preoperative NANO scale improved significantly at postoperative follow-up assessment (P = 0.0036) from a preoperative median score of 3 to 1 at follow-up (C). Abbreviations: Pre-op, preoperative; post-op, postoperative; KPS, Karnofski Performance Scale; NANO, The Neurologic Assessment in Neuro-Oncology
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