Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age

2012 ◽  
Vol 116 (2) ◽  
pp. 357-364 ◽  
Author(s):  
Ági Oszvald ◽  
Erdem Güresir ◽  
Matthias Setzer ◽  
Hartmut Vatter ◽  
Christian Senft ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factor ◽  
Elderly Patients ◽  
Clinical Status ◽  
Combined Treatment ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Karnofsky Performance Scale ◽  
Extensive Resection ◽  
Younger Patients

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.

scholarly journals Glioblastoma in the elderly: the effect of aggressive and modern therapies on survival

2016 ◽  
Vol 124 (4) ◽  
pp. 998-1007 ◽  
Author(s):  
Ranjith Babu ◽  
Jordan M. Komisarow ◽  
Vijay J. Agarwal ◽  
Shervin Rahimpour ◽  
Akshita Iyer ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Median Survival ◽  
Standard Of Care ◽  
Extent Of Resection ◽  
Older Age ◽  
Karnofsky Performance Scale ◽  
Subtotal Resection ◽  
Newly Diagnosed ◽  
Complication Risk

OBJECT The prognosis of elderly patients with glioblastoma (GBM) is universally poor. Currently, few studies have examined postoperative outcomes and the effects of various modern therapies such as bevacizumab on survival in this patient population. In this study, the authors evaluated the effects of various factors on overall survival in a cohort of elderly patients with newly diagnosed GBM. METHODS A retrospective review was performed of elderly patients (≥ 65 years old) with newly diagnosed GBM treated between 2004 and 2010. Various characteristics were evaluated in univariate and multivariate stepwise models to examine their effects on complication risk and overall survival. RESULTS A total of 120 patients were included in the study. The median age was 71 years, and sex was distributed evenly. Patients had a median Karnofsky Performance Scale (KPS) score of 80 and a median of 2 neurological symptoms on presentation. The majority (53.3%) of the patients did not have any comorbidities. Tumors most frequently (43.3%) involved the temporal lobe, followed by the parietal (35.8%), frontal (32.5%), and occipital (15.8%) regions. The majority (57.5%) of the tumors involved eloquent structures. The median tumor size was 4.3 cm. Every patient underwent resection, and 63.3% underwent gross-total resection (GTR). The vast majority (97.3%) of the patients received the postoperative standard of care consisting of radiotherapy with concurrent temozolomide. The majority (59.3%) of patients received additional agents, most commonly consisting of bevacizumab (38.9%). The median survival for all patients was 12.0 months; 26.7% of patients experienced long-term (≥ 2-year) survival. The extent of resection was seen to significantly affect overall survival; patients who underwent GTR had a median survival of 14.1 months, whereas those who underwent subtotal resection had a survival of 9.6 months (p = 0.038). Examination of chemotherapeutic effects revealed that the use of bevacizumab compared with no bevacizumab (20.1 vs 7.9 months, respectively; p < 0.0001) and irinotecan compared with no irinotecan (18.0 vs 9.7 months, respectively; p = 0.027) significantly improved survival. Multivariate stepwise analysis revealed that older age (hazard ratio [HR] 1.06 [95% CI1.02–1.10]; p = 0.0077), a higher KPS score (HR 0.97 [95% CI 0.95–0.99]; p = 0.0082), and the use of bevacizumab (HR 0.51 [95% CI 0.31–0.83]; p = 0.0067) to be significantly associated with survival. CONCLUSION This study has demonstrated that GTR confers a modest survival benefit on elderly patients with GBM, suggesting that safe maximal resection is warranted. In addition, bevacizumab significantly increased the overall survival of these elderly patients with GBM; older age and preoperative KPS score also were significant prognostic factors. Although elderly patients with GBM have a poor prognosis, they may experience enhanced survival after the administration of the standard of care and the use of additional chemotherapeutics such as bevacizumab.

scholarly journals Survival of glioblastoma in relation to tumor location: a statistical tumor atlas of a population-based cohort

2021 ◽  
Author(s):  
Even Hovig Fyllingen ◽  
Lars Eirik Bø ◽  
Ingerid Reinertsen ◽  
Asgeir Store Jakola ◽  
Lisa Millgård Sagberg ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factor ◽  
Elderly Patients ◽  
Temporal Lobe ◽  
Third Ventricle ◽  
Tumor Location ◽  
Population Based ◽  
Independent Effect ◽  
Precentral Gyrus ◽  
The Third

Abstract Purpose Previous studies on the effect of tumor location on overall survival in glioblastoma have found conflicting results. Based on statistical maps, we sought to explore the effect of tumor location on overall survival in a population-based cohort of patients with glioblastoma and IDH wild-type astrocytoma WHO grade II–III with radiological necrosis. Methods Patients were divided into three groups based on overall survival: < 6 months, 6–24 months, and > 24 months. Statistical maps exploring differences in tumor location between these three groups were calculated from pre-treatment magnetic resonance imaging scans. Based on the results, multivariable Cox regression analyses were performed to explore the possible independent effect of centrally located tumors compared to known prognostic factors by use of distance from center of the third ventricle to contrast-enhancing tumor border in centimeters as a continuous variable. Results A total of 215 patients were included in the statistical maps. Central tumor location (corpus callosum, basal ganglia) was associated with overall survival < 6 months. There was also a reduced overall survival in patients with tumors in the left temporal lobe pole. Tumors in the dorsomedial right temporal lobe and the white matter region involving the left anterior paracentral gyrus/dorsal supplementary motor area/medial precentral gyrus were associated with overall survival > 24 months. Increased distance from center of the third ventricle to contrast-enhancing tumor border was a positive prognostic factor for survival in elderly patients, but less so in younger patients. Conclusions Central tumor location was associated with worse prognosis. Distance from center of the third ventricle to contrast-enhancing tumor border may be a pragmatic prognostic factor in elderly patients.

Lymphatic Leakage after Surgery for Neuroblastoma: A Rare Complication?

2020 ◽  
Author(s):  
Alexandra Froeba-Pohl ◽  
Jakob Muehling ◽  
Katharina Vill ◽  
Veit Grote ◽  
Tim Komm ◽  
...  
Keyword(s):  
Overall Survival ◽  
Rare Complication ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Mycn Amplification ◽  
Study Cohort ◽  
Common Complication ◽  
Lymphatic Duct ◽  
Extent Of Surgery

Abstract Introduction Neuroblastoma is the most common extracranial solid tumor in infancy. It is responsible for around 15% of all oncological deaths during childhood. Due to its retroperitoneal location, neuroblastoma is invasively growing directly in and around the lymphatic duct. Consecutively, lymphatic leakage (LL) after surgery for neuroblastoma is a known complication. The purpose of this study is the investigation of frequency and impact of this complication. Material and Methods Between February 2003 and December 2016, 204 patients with neuroblastoma received surgical treatment in our department. A retrospective analysis for macroscopical extent of resection, duration of drainage postsurgery, maximum amount of fluid drained in 24 hours, MYCN amplification status, therapeutic options for LL, follow-up status, and overall survival was performed. Results A total of 40% of patients (82/204) showed LL to some extent. In patients with MYCN amplification, LL was seen significantly more often than in patients without MYCN amplification status (p = 0.019). LL was also significantly correlated with extent of surgery (p = 0.005). Follow-up status and overall survival were significantly inversely associated with LL (p = 0.004 and p = 0.0001). LL was self-limiting in all cases. There was a trend toward shorter duration of LL if either no special therapy was chosen or total parenteral nutrition (TPN) was administered (p = 0.0603). Conclusion We show that LL in neuroblastoma is a common complication of tumor resection and occurring more often than anticipated. Since, in our study cohort, all cases of LL were self-limiting, we question the indication for invasive therapy besides supporting measures.

scholarly journals Cortical plasticity catalyzed by prehabilitation enables extensive resection of brain tumors in eloquent areas

2017 ◽  
Vol 126 (4) ◽  
pp. 1323-1333 ◽  
Author(s):  
Paola A. Rivera-Rivera ◽  
Marcos Rios-Lago ◽  
Sandra Sanchez-Casarrubios ◽  
Osman Salazar ◽  
Miguel Yus ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Behavioral Training ◽  
Brain Areas ◽  
Extensive Resection ◽  
Who Grade ◽  
Stimulation Intensity ◽  
Eloquent Areas ◽  
Cortical Electrical Stimulation

OBJECTIVE The extent of resection is the most important prognostic factor following brain glioma surgery. However, eloquent areas within tumors limit the extent of resection and, thus, critically affect outcomes. The authors hypothesized that presurgical suppression of the eloquent areas within a tumor by continuous cortical electrical stimulation, coupled with appropriate behavioral training (“prehabilitation”), would induce plastic reorganization and enable a more extensive resection. METHODS The authors report on 5 patients harboring gliomas involving eloquent brain areas within tumors as identified on intraoperative stimulation mapping. A grid of electrodes was placed over the residual tumor, and continuous cortical electrical stimulation was targeted to the functional areas. The stimulation intensity was adjusted daily to provoke a mild functional impairment while the function was intensively trained. RESULTS The stimulation intensity required to impair function increased progressively in all patients, and all underwent another operation a mean of 33.6 days later (range 27–37 days), when the maximal stimulation voltage in all active contacts induced no functional deficit. In all cases, a substantially more extensive resection of the tumor was possible. Intraoperative mapping and functional MRI demonstrated a plastic reorganization, and most previously demonstrated eloquent areas within the tumor were silent, while there was new functional activation of brain areas in the same region or toward the contralateral hemisphere. CONCLUSIONS Prehabilitation with continuous cortical electrical stimulation and appropriate behavioral training prior to surgery in patients with WHO Grade II and III gliomas affecting eloquent areas accelerate plastic changes. This can help maximize tumor resection and, thus, improve survival while maintaining function.

Elderly Patients with Early-Unfavorable Stage Hodgkin’s Disease (HD) Have a Poorer Outcome When Treated with Combined Modality Treatment and Extended Field Radiotherapy (EF): A Retrospective Analysis of the German Hodgkin Study Group.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1305-1305
Author(s):  
Andreas Engert ◽  
Heinz Haverkamp ◽  
Hans T. Eich ◽  
Andreas Josting ◽  
Beate Pfistner ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
The Elderly ◽  
Combined Modality Treatment ◽  
Study Group ◽  
Younger Patients ◽  
German Hodgkin Study Group ◽  
Mediastinal Tumours ◽  
Extended Field ◽  
Involved Field

Abstract Purpose: The HD8 study of the German Hodgkin Study Group (GHSG) demonstrated that involved field (IF) radiotherapy is equally effective when compared with EF radiotherapy after four cycles of chemotherapy (2 x COPP/ABVD). Since there are indications that elderly patients with HD might fare worse depending on the type of treatment applied, we revisited the HD8 data for possible differences between younger and older patients. Methods and results: A total of 1204 patients were randomised to receive two double cycles of COPP/ABVD and either 30 Gy EF + 10 Gy bulk or 30 Gy IF + 10 Gy bulk. Of these, 98 evaluable patients were older than 60 years and 1038 patients were younger than 60 years. In general, there were more risk factors such as B-symptoms, elevated ESR, and poorer Karnofski index in the elderly group. On the other hand, there were fewer bulky tumours, large mediastinal tumours and a lower number of lymph node areas involved in elderly patients. The toxicity of treatment was more pronounced in elderly patients with 76 of 96 patients experiencing chemotoxicity Grade III or IV (79%) compared with 699 of 1018 (69%) in those younger than 60 years. After a median follow up of 52 months, the 5-year-FFTF was 85% in younger patients and 63% in patients older than 60 years (p &lt;0.001). The 5-year-overall survival was 94% for patients younger than 60 years and 66% for patients older than 60 years (p &lt; 0.001). In addition, patients older than 60 years treated with EF had a trend for worse FFTF and overall survival compared to those receiving IF radiotherapy. Conclusion: Event-free and overall survival of patients older than 60 years old are worse compared with younger patients. In particular, patients older than 60 years receiving EF radiotherapy had a poorer prognosis.

Impact of expression of SIRT1 and SIRT2 on outcome in the very elderly patients with colorectal cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15107-e15107
Author(s):  
In Sook Woo ◽  
Yun Hwa Jung ◽  
In Kyu Lee
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factor ◽  
Elderly Patients ◽  
Young Patients ◽  
High Expression ◽  
Very Elderly ◽  
Poor Prognostic Factor ◽  
Younger Patients ◽  
Sirt1 Expression ◽  
The Impact

e15107 Background: Surtuins(SIRTs), NAD+-dependent deacetylases, participate in cell metabolism and ageing associated diseases including cancer. The elderly has higher cancer incidence and mortality compared to the young. Many of patients with colorectal cancer are over the age of 80. The role of SIRT 1 and 2 in tumorigenesis remains debated and it has not been reported for the very elderly patients with cancer. We investigated the relationship of clinicopathologic parameters and expression of SIRT1 and 2 in colorectal cancer patients 80 years of age or older and the impact of ageing comparing with the younger patients. Methods: The expression of SIRT1 and 2 were evaluated in colorectal cancer tissues of 101 patients aged ≥80 years and 29 patients aged ≤40 years by immunohistochemistry. And correlations between expression of these proteins and clinicopathological features were analyzed. Results: High expression of SIRT1 was observed in 65/101 (64.4%) elderly patients and 11/29 (37.9%) young patients(p = 0.011). Similarly, high expression of SIRT2 was more commonly observed in 58/99 (58.6%) elderly patients than 8/29 (27.6%) young patients(p = 0.003). In all patients high SIRT2 expression was associated with comorbid DM, and stage of CRC were not associated with SIRT1 or SIRT2 expression status. Comparison of Kaplan-Meier survival curve using log rank test revealed that high expressions of SIRT1 and SIRT2 were significantly associated with worse prognosis (median OS 24.9ms vs 38.6ms, p = 0.027) and better prognosis (median OS 37.9ms vs 17.3ms, p = 0.006) respectively in elderly patients. No prognostic significances were observed in younger patients. In multivariate analysis, only high SIRT1 expression retained statistical significance as a poor prognostic factor in elderly patients with CRC. Conclusions: :High SIRT1 expression might become a significant poor prognostic factor for elderly CRC patients although further study is needed for younger patients to clarify the difference of expression according to the age between elderly and young patients with CRC. High SIRT2 expression showed association with comorbid DM, further studies are warranted to establish prognostic significance in CRC patients.

SURG-08. SARCOPENIA IS A PROGNOSTIC FACTOR OF 90-DAY MORTALITY AND OVERALL SURVIVAL IN ELDERLY PATIENTS WITH GLIOBLASTOMA

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi196-vi196
Author(s):  
Ramin Morshed ◽  
Jacob Young ◽  
Megan Casey ◽  
Elaina Wang ◽  
Manish K Aghi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Life Expectancy ◽  
Adjuvant Therapy ◽  
Elderly Patients ◽  
Tumor Resection ◽  
Preoperative Imaging ◽  
Imaging Features ◽  
Who Grade ◽  
Treatment Data

Abstract Elderly patients with glioblastoma (GBM) have worse overall prognosis compared to younger patients and are less likely to undergo tumor resection and adjuvant therapy. The goal of this study was to identify patient and treatment factors as well as preoperative imaging features associated with worse overall survival and death within 3 months of surgery in elderly GBM patients. A single-center retrospective study was conducted with patients who met the following inclusion criteria: 1) age ≥ 79 at surgery (past the average age of life expectancy), 2) underwent biopsy or resection of an IDH-wildtype WHO Grade IV GBM at the time of initial diagnosis, and 3) had no prior radiation or chemotherapy. Patient, imaging, and treatment data were collected retrospectively from the electronic medical record. Univariate and multivariate Cox proportional hazard and logistic regression analyses were performed to identify factors associated with overall survival and 90-day mortality. The cohort consisted of 110 patients with a mean age of 82.8 (range 79 to 94.1) at surgery and a median preoperative KPS of 80. Thirty-seven (33.6%) and 73 (66.4%) patients underwent biopsy and resection, respectively. Adjuvant chemo- and/or radiation therapy were used in 72.5% of cases. On multivariate analysis, age (HR 1.13 by year, p=0.01), increased masseter thickness (HR 0.88 by mm, p=0.049), adjuvant therapy (HR 0.05, p&lt; .0001), and surgical resection rather than biopsy (HR 0.38, p=0.0007) were associated with improved survival. Decreased masseter thickness was the only preoperative factor on analysis that predicted 90-day mortality in the cohort (p=0.038). GBM patients past the average age of life expectancy still fare better when undergoing resection followed by adjuvant chemotherapy and radiation therapy. In addition to treatment factors that predict survival, smaller masseter diameter on preoperative imaging, a marker of sarcopenia, is associated with shorter survival and death within 90 days of surgery.

Continuous Decrease of Overall Survival in Patients > 30 Years of Age with Acute Myelogenous Leukemia.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 998-998
Author(s):  
Utz O. Krug ◽  
Wolfgang Berdel ◽  
Susanne Amler ◽  
Maria C. Sauerland ◽  
Bernhard Wörmann ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Prognostic Factor ◽  
Induction Therapy ◽  
Age Groups ◽  
Myelogenous Leukemia ◽  
Age At Diagnosis ◽  
Age Group ◽  
Free Survival ◽  
Younger Patients

Abstract Abstract 998 Poster Board I-20 Introduction: Age at diagnosis is a well established prognostic factor in acute myeloid leukemia, since elderly patients exhibit a very bad prognosis compared to younger patients. However, little is known about the influence of age within different age groups. Patients and Methods: 2874 patients of > 16 years of age were treated in the AMLCG1999 study of the AML Co-operative Group with a standard- and high-dose cytarabine-containing combination induction therapy (TAD/HAM), standard-dose cytarabine containing consolidation therapy (TAD) and different schedules of postremission therapy (allogeneic or autologous stem cell transplantation, maintenance therapy). Patients were grouped into into 5 age categories (< 30 years, 30 – 44, 45 – 59, 60 – 74 and ≥ 75 years) and were analyzed for remission rate (RR), overall survival (OS), event-free survival (EFS), relapse-free survival (RFS) and freedom from relapse (relapse free interval, RFI). Results: The RR after an intensive induction therapy steadily declined from 76.2% to 44.6% with increasing age (see table). However, despite the superior RR in patients < 30 years these patients displayed a not significantly decreased RFS and RFI in the postremission phase compared to the age group 30 – 44 years. As a result, OS and EFS did not differ between the age groups < 30 years and 30-44 years but decreased with increasing age for the age groups < 45, 45 – 59, 60 – 74 and ≥ 75 years. Younger patients displayed leukocytes > 20,000/μl more often (51.1%, 46.5%, 37.4%, 34.6%, 40.4% for the age groups < 30, 30-44, 45 – 59, 60 – 74 and ≥ 75 years respectively), a higher amount of patients with elevated LDH > 700U/l (39.0%, 31.3%, 24.3%, 20.4%, 20.2%), a higher amount of low risk cytogenetics as defined by the presence of CBF aberrations (20.9%, 14.6%, 8.3%, 3.7%, 4.8%) and the lowest incidence of high risk cytogenetics (19.4%, 20.8%, 23.4%, 29.6%, 21.9%). When adjusted for these risk factors in a multivariate analysis, age remained an independent factor for RR together with the cytogenetic risk profile. Age remained a significant adverse prognostic factor for OS in a multivariate analysis showing a decrease for the age groups < 45 years, 45 – 59 years, 60 – 74 years and ≥ 75 years. RFI was significantly worse in the age group ≥ 60 years versus < 60 years but did not differ within these age groups. Conclusion: Taken together, we found age to be a continuous adverse risk factor for the probability of a complete remission in adult AML patients above 30 years of age at diagnosis receiving an intensive induction treatment. Age has previously been shown to be the strongest independent prognostic factor when patients are stratified between the age groups < 60 and ≥ 60 years of age. In our analysis, we could also demonstrate an influence of the age on overall survival within these age groups. Disclosures: No relevant conflicts of interest to declare.

A Prospective, Multicenter Phase II Study Of Continuous Infusion Of FLAG For Patients Older Than 60 Years With Resistant Acute Myeloid Leukemia: A Comparison With Intensive Younger patients’ Trial

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3968-3968
Author(s):  
Hawk Kim ◽  
Je-Hwan Lee ◽  
Young-Don Joo ◽  
Sung-Hwa Bae ◽  
Jung-Hee Lee ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Treatment Failure ◽  
Continuous Infusion ◽  
Phase Ii ◽  
Myeloid Leukemia ◽  
Phase Ii Study ◽  
Younger Patients ◽  
Acute Myeloid

Abstract Relapsed/refractory acute myeloid leukemia (R/R AML) is hard to treat especially in elderly patients. We previously assessed continuous infusion (CI) of fludarabine and cytarabine plus idarubicin (CI-FLAG2) for patients under 65-years old with R/R AML. Also we started prospective phase II study of attenuated version of CI-FLAG2 for elderly patients (C-FLAG). R/R AML in elderly (¡Ã60 years old) patients were eligible. Induction chemotherapy consisted fludarabine and cytarabine (ARAC) as a 24-hr CI without idarubicin. Total 38 and 68 patients were enrolled in CI-FLAG1 and CI-FLAG2, respectively. There were no differences in terms of patients’ characteristics except for median age (p<0.001), HCT prior to salvage (p=0.002), WBC>20K/uL at salvage (p=0.004) and PB blast>40% at salvage, all which factors were unfavorable in C-FLAG. When comparing outcomes between CI-FLAG2 and C-FLAG, there were no difference in terms of CR rate (p=0.572) and objective response rate (ORR; p=0.899). Treatment failure patterns were also similar between C-FLAG and CI-FLAG2 (p=0.742). The most common treatment failure was resistant (66.7%) in C-FLAG. There were more frequent HCT in CI-FLAG2 (p<0.001) and consolidation chemotherapy in C-FALG (p=0.001). Poor predictors on ORR in C-FLAG were PB WBC>20K/uL at salvage (p=0.024) and PB blast >0% on early evaluation (p=0.013) by multivariate analysis. The overall survival of patients who achieve CR/CRp/CRi showed significantly prolonged survival compared with patients who did not in C-CLAG (p<0.001; Figure 1A). The median overall survivals were similar between CI-FLAG2 and C-FALG (p=0.427; Figure 1B).Figure 1Overall survivalFigure 1. Overall survival Attenuated salvage regimen C-FALG in elderly patients was as effective as more intensive younger patients’ regimen CI-FALG2 in terms of response and survival although elderly patients had more unfavorable clinical characteristics. Disclosures: No relevant conflicts of interest to declare.

An extent of resection threshold for recurrent glioblastoma and its risk for neurological morbidity

2014 ◽  
Vol 120 (4) ◽  
pp. 846-853 ◽  
Author(s):  
Mark E. Oppenlander ◽  
Andrew B. Wolf ◽  
Laura A. Snyder ◽  
Robert Bina ◽  
Jeffrey R. Wilson ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Benefit ◽  
Tumor Volume ◽  
De Novo ◽  
Extent Of Resection ◽  
Cox Proportional Hazards ◽  
Recurrent Glioblastoma ◽  
Karnofsky Performance Scale ◽  
Neurological Morbidity

Object Despite improvements in the medical and surgical management of patients with glioblastoma, tumor recurrence remains inevitable. For recurrent glioblastoma, however, the clinical value of a second resection remains uncertain. Specifically, what proportion of contrast-enhancing recurrent glioblastoma tissue must be removed to improve overall survival and what is the neurological cost of incremental resection beyond this threshold? Methods The authors identified 170 consecutive patients with recurrent supratentorial glioblastomas treated at the Barrow Neurological Institute from 2001 to 2011. All patients previously had a de novo glioblastoma and following their initial resection received standard temozolomide and fractionated radiotherapy. Results The mean clinical follow-up was 22.6 months and no patient was lost to follow-up. At the time of recurrence, the median preoperative tumor volume was 26.1 cm3. Following re-resection, median postoperative tumor volume was 3.1 cm3, equating to an 87.4% extent of resection (EOR). The median overall survival was 19.0 months, with a median progression-free survival following re-resection of 5.2 months. Using Cox proportional hazards analysis, the variables of age, Karnofsky Performance Scale (KPS) score, and EOR were predictive of survival following repeat resection (p = 0.0001). Interestingly, a significant survival advantage was noted with as little as 80% EOR. Recursive partitioning analysis validated these findings and provided additional risk stratification at the highest levels of EOR. Overall, at 7 days after surgery, a deterioration in the NIH stroke scale score by 1 point or more was observed in 39.1% of patients with EOR ≥ 80% as compared with 16.7% for those with EOR < 80% (p = 0.0049). This disparity in neurological morbidity, however, did not endure beyond 30 days postoperatively (p = 0.1279). Conclusions For recurrent glioblastomas, an improvement in overall survival can be attained beyond an 80% EOR. This survival benefit must be balanced against the risk of neurological morbidity, which does increase with more aggressive cytoreduction, but only in the early postoperative period. Interestingly, this putative EOR threshold closely approximates that reported for newly diagnosed glioblastomas, suggesting that for a subset of patients, the survival benefit of microsurgical resection does not diminish despite biological progression.

Sign in / Sign up

Export Citation Format

Share Document